Who is to blame for the bullying epidemic?
Jennifer Wressell MACN
I have worked in health since I was 18, first as a personal care assistant in a nursing home and then as a registered nurse, employed across acute care, remote indigenous communities, aged care and community health. In 2016 I moved out of the health care industry and into science and exploration, managing tradies and scientists over a winter in Antarctica for the Australian Antarctic Division. For ten months I was responsible for a group of people in a very isolated location, and one of the team members was a bully. My experiences in managing this bully were very different to my previous experiences managing bullies in the health care industry. The behaviours that the rest of the team identified, found difficult to cope with and needed assistance understanding were initially not obvious to me, something that I found difficult to understand.
Fortunately concurrently with my expedition leader position I was also undertaking a study into workplace violence through Deakin University. One day the bullying behaviour that I was observing, the effect that it was having on the team and the literature that I was reading suddenly made sense. I had a light bulb moment of insight into how entrenched bullying behaviours are in the health industry, how often we accept workplace violence as normal, part of the job and inevitable. I was struggling to see the bullying behaviour my staff member was displaying because his behaviour seemed almost normal to me after over 30 years in the health industry. I started to ask, who’s to blame? Is our organisational or professional culture to blame? Is health full of bullies or do we create them? What can we change? What can we do differently?
Bullying is defined in Australia as repeated and unreasonable behaviour directed towards a worker or group of workers that creates a risk to health and safety (Safe Work Australia, 2016). In the health care industry and more pertinently, nursing, over 50% of nursing students have experienced bullying and/or harassment during their clinical placements (Budden, Birks, Cant, Bagley & Park, 2017). CRANA (2017) found that 77% of remote area nurses had witnessed colleagues leaving their position due to bullying and/or harassment. 40% of nurses in hospital-based roles reported regular bullying over the preceding 12 months (Frost, 2016). Compared to bullying and/or harassment figures across all occupations in Australia, nursing demonstrated a high level of exposure. In 2014–15, 9.4% of workers across all industries experienced bullying in the preceding 6 months (SafeWork, 2016). Nursing has long acknowledged the issue with bullying or horizontal violence within our industry, but we don’t seem to have been able to change the professional or organisational culture and reduce the levels. There are many theories about why nursing has developed a professional culture of bullying and exploring these can provide insight into how we can change.
Organisational culture is a system of shared assumptions, values and beliefs which govern how people behave in an organisation. Organisational culture is demonstrated publicly through a vision, values statement or organisational mission. As nurses, we also have a professional culture that we work within. Our professional culture is developed in the same way as an organisational culture, a set of shared assumptions, values and beliefs that govern how we behave within our profession. In nursing our professional culture is publicly displayed though our Nursing and Midwifery Board Code of Conduct and professional organisations like the Australian College of Nursing. But what about behind the scenes, are our public vision and values reflected in our behaviours? If not why not.
SafeWork Australia (2016) identifies four possible reasons for why bullying occurs.
- Psychosocial Safety Change Hypothesis – a lack of managerial regard for workplace psychological health and safety leads to poor work and in turn bullying and harassment.
- Productivity Hypothesis – bullying and harassment are a means to obtain more productivity from workers
- Retain – and-build Personal Power Hypothesis – bullying and harassment are tactics to maintain the status quo of personal power distribution within organisations
- Work environment hypothesis – poor quality work in terms of task and job design, such as high levels of demands and low levels of resources, precipitates bullying and harassment.
All of these hypotheses revolve around the relationship between power, work pressures and available resources. An alternate theory is the idea of desensitisation.
This theory drawn from psychology has demonstrated that exposure to violence can, over time, reduce a person’s arousal state (Krahe, Moller, Huesmann, Kirwil, Felber & Berger, 2011) ie. their fight or flight reaction. With up to 90% of nurses regularly subjected to verbal and physical workplace violence from clients (Reknes, Notelaers, Mageroy, Pallessen, Bjorvatn, Moen & Einarsen, 2017), nurses can become desensitised to violence. Over time and as we become desensitised through multiple experiences of workplace violence, we fail to recognise the effect that it is having on ourselves and the way that we interact with each other. Following an incident of client mediated violence, the immediate and sometimes subconscious response is increased feelings of anger and frustration which can manifest as internal workplace violence displayed as irritability, anger or hostility towards co-workers (Gates, Gillespie & Succop, 2011).
One of the oldest theories around bullying has been that nurses engage in oppressed group behaviour, defined as “…an individual or group (who) not only feels but is relatively powerless compared to another, can take it (frustration) out on each other within the oppressed group, especially on some-one even less powerful”. This theory has been floated since the early 1980s and references the power dynamic between nursing (feminine) and medicine (masculine) as well as societal power dynamics (Roberts, Demarco & Griffin, 2009).
These theories create a picture of why bullying is so prevalent in nursing. Nursing is a profession with a basis in advocacy, health promotion and compassion, however too often we see slow and quiet organisational implosion demonstrated as disengaged employees or professionals, low quality service, high turnover, increasing sick leave and consumer complaints. If we can understand why bullying levels are so high, then we can take steps to create congruence between our espoused organisational and professional values and vision and our behaviours. So let’s think about how we can redefine work roles and resource allocation to support each other. Let’s consider the effect of client-mediated violence on our colleagues, support each other. Examine your personal levels of desensitisation; do you internalise the feeling of frustration and anger following an incident? Do you find you are more irritable following an incident of occupational violence even when the incident seems minor? Do you support a colleague after witnessing an incident of workplace violence, even when your colleague says they are okay? Let’s try to create organisational and professional cultures where our values and vision match our behaviours, assumptions and intentions.
Budden,L., Birks,M., Cant,R., Bagley,T. & Park, T. (2017). Australian nursing students’ experience of bullying and / or harassment during clinical placement. Collegian, 24, pg 125 – 133
CRANA (2017). Remote health workforce safety & security report: Literature review, consultation & survey report. CRANAplus, Cairns.
Frost,P. (2016) Victorian Auditor-General’s Report; Bullying and Harassment in the Health Sector. Victorian Government Printers.
Gates,D., Gillespie,G. & Succop,P. (2011) Violence against nurses and its impact on stress and productivity. Nursing Economics, 29, 59-67
Krahe, B., Moller, I., Huesmann,L., Kirwil,L., Felber,J. & Berger,A. (2011). Desensitization to media violence: Links with habitual media violence exposure, aggressive cognitions, and aggressive behaviour. Journal of Personality and Social Psychology, April, 630 – 646.
National Institute for Occupational Safety and Health (NIOSH). (2016). Oppressed Group Behaviour sourced at https://wwwn.cdc.gov/wpvhc/Course.aspx/Slide/Unit4_6
Reknes,I., Notelaers,G., Mageroy,N., Pallessen,S., Bjorvatn,B., Moen,B. & Einarsen,S. (2017) Aggresion from patients or next of kin and exposure to bullying behaviours: A conglomerate experience? Nursing Research and Practice,
Roberts,S., Demarco,R. & Griffin,M. (2009) The effect of oppressed group behaviours on the culture of the nursing workplace: a review of the evidence and interventions for change. Jounral of Nursing Management, 17, 288 – 293.
Safe Work Australia (2016) Bullying & Harrassment in Australian Workplaces: Results from the Australian workplace Barometer Project 2014 / 15. Safe Work Australia, Canberra ACT.
Seeger,M. & Ulmer,R. (2003). Explaining Enron: Communication and Responsible Leadership. Management communication Quarterly, 17 (1), 58 – 84.
Through my experiences as a new nurse I found there was little training or development put in place in regards to appropriate professional behaviour, how to remedy and report situations which make you feel compromised, safe pathways to follow if you feel unheard, clinical skills training consistent with the best available evidence and supported conversations to discuss and reflect on ward behaviour as a group in a controlled and healthy environment.
I have noticed some healthcare providers believe the onus is on the nurse to maintain professional development and access needed clinical training and support outside scheduled work hours. If this direction is taken an accessible third party nurse development institute should be developed for nurses including face to face compentency training, communication and organisational behaviour training, conflict resolution and so on.
Nurses are finding it hard to get experience, those that do find the opportunity often struggle within the organisational environment and healthcare culture. In saying that experienced nurses also have the need to access quality, one on one and group training which gives them support and verification they are practicing professionally and consistently with the best available evidence.
In order to improve the health care culture, ensure patient safety and be accountable in our practice nurses need be given the opportunity to participate in financially viable, accessible and certified courses to empower them, share knowledge, increase confidence and enable nurses to practice to their full potential.
The above is a very intelligent post. I imagine the person above was given a hard time because they are intelligent. Bullies quite often are not the high achievers so they resort to bullying to get what they want, and even when promoted they learn tactics on how to stay afloat. What I would like to see is a genuine merit based system for hiring and promoting people, because if the cream does not get to the top then people will think what is the point and walk away from nursing, taking with them good ideas. I think a more question based interview would be better because with the interviews they can say either you are wuffling or you are not elaborating enough. Quite often it is very subjective as to what is middle ground. So in effect, an organisation will not excel or do as well as it could do if they are not truly merit based. Bullying does need to stop because it can impact on patients and that is not fair at all. People who deliberately use bullying tactics should be given warning letters and then fired if they don’t stop. Managers should also learn to delve into situations rather than being lazy and believing any allegations. They need to make it clear when speaking to a staff member that the comment or comments are allegations but they intend to look into the matter properly, and give the person that has been called into their office 24 hours of breathing space to come back if they want to add anything else. It is very stressful being put on the spot. Some managers need to wake up and realise that they could end up in hospitals themselves and they need a culture of collaborative nurses to ensure proper safety.