Bullying in Nursing | It’s Not Just For Kids | Mean Girls

February 15, 2014

best ging beth israel phillips cropped 1024x534 Bullying in Nursing | Its Not Just For Kids | Mean Girls

I was a travel nurse (far left) on this unit in NYC where I met the most destructive nurse in all of my career (she’s in there, too).

My colleagues who work far away from the hospital bedside don’t see the severity of bullying in nursing.  My friends outside of healthcare think it’s a joke because the term “bullying” is associated with kids.  But I assure you it is a serious problem in the profession and it compromises patient safety.

Exposure:  What is Taking so Long?

The phenomenon of lateral violence, or bullying, is well known among seasoned nurses but it remains a mystery to outsiders.  Exposing the problem is the first step in fixing it and nurses are beginning to wonder what is taking so long.

One reason is due to the lack of evidence to support its existence.  There is a saying in nursing that, “if you didn’t chart it, you didn’t do it.”  The same applies to bullying.  If there isn’t peer-reviewed research to support it, then it doesn’t exist.  Only recently has empirical data in sufficient quantity been published that identifies and reports the prevalence of bullying.

Also, widespread news of nurse bullying may deter prospective nurses from entering the profession.  Nurse staffing levels in hospitals are at about 80% right now and slowly declining.  A full-blown nursing shortage is expected in 2020 and without new graduate nurses we don’t stand a chance.

Causes:  Low Self-Esteem, Limited Communication Skills & Lack of Control

Thankfully the whispers about nurse bullying have evolved into a conversation and attention is being directed at the issue.  However, nurses at the bedside continue to be victimized by their peers.

Identifying the causes of lateral violence is the next step.  There are many reasons that bulling exists in nursing and it is a complex topic.  But, generally speaking, most bullies in nursing have low self-esteem along with a limited communication skill set.

Unfortunately, there are many risk factors for low self-esteem ranging from a dysfunctional family life to a genetic predisposition for depression.  Some people are truly unaware of their own low self-esteem and haven’t got a clue how to help themselves.

Interpersonal communication is a skill, meaning it is learned.  Children who come from certain backgrounds do not learn effective verbal communication and have to assume that responsibility as adults.  Some choose to learn and others do not.

Additionally, bullies report feeling a lack of control regarding their position on the job.  Examples of this include fear of being fired, limited advancement opportunities, or unsupportive management.  The inability to communicate these factors (because of limited communication skills or low self-esteem) further compounds feelings of frustration.  Instead of constructively expressing the frustration, it is unfortunately, inflicted upon unsuspecting coworkers in the form of bullying.

Solutions:  Education, Leadership & Hospital Policy

Self-esteem and communication skills can be bolstered through education, however the educational requirements for nursing are minimal.  A 4-year degree dramatically improves communication skills and a sense of empowerment but only 1/3 of nurses have one.  Legislation requiring all potential nurses to obtain a bachelor’s degree before taking the NCLEX is a viable solution.

Along with increased education, hospitals need to stop filling management positions with warm bodies and instead, fill those positions with leaders.  Much research has been published regarding effective leadership but hospital HR departments struggle to find nurse applicants with those skills.  This means that nursing programs must go beyond teaching tasks and begin to create leaders.

HR faces another problem when executive staff members do not provide a clear zero-tolerance, anti-bullying policy.  Unfortunately unions complicate matters by making it very difficult to fire bullies.

Bottom Line

Everyone from hospital executives to nursing students need to be made aware of lateral violence in the profession of nursing in an effort to end it.  Hospital decision makers need to put leaders in place who can create safe environments for bedside nurses.  Nursing students need to be prepared as leaders who can manage a challenging work environment.  Staff nurses need to advocate for each other when they witness bullying.

More Information

In 2010, Jennifer Embree and Ann White compiled a literature review and I highly recommend you take a look.

 

For additional nurse blogger posts on bullying in nursing check out the Nurse Blog Carnival.

To read my advice for a University of Texas student on becoming a nurse click HERE.

Also, you might like my foreign educated nurses post.

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30 comments

Comments (30)

  1. I’m so glad to finally see someone bring this issue out in to the open. One thing that hasn’t been addressed, is the other strong possibility, that this could also be starting in the classroom (at nursing schools). Students fear reporting because they don’t want to be “that person” and staff have no understanding of how to deal with it, if they even realize it exists. Several disturbing situations in a classroom have been explained to me. My reaction has been, “how can this be? This isn’t normal? People don’t REALLY behave this way.” Sadly, it appears the reasons you sited have a huge impact on the reason for bullying. In a classroom situation, I would go as far to say that it could largely be due to low self-esteem and fear of performing poorly. Academically challenged students are threatened by their peers that appear to “outshine” them. It is so difficult to understand why everyone can’t mind their own business and stick to their studies. What really frightens me is that many of these bullies are about to be let loose in the medical world. Scary on too many levels. Thank you for putting this out there. I hope the conversation continues. I hope solutions arise. I hope some of the student bullies read and recognize themselves, and stop the junior high, mean girl mentality.

    • There is so much to write about this topic that I couldn’t fit it all in but I could go on and on.

      Last year I attended a bullying seminar for school-age kids K-12. Bullying for that age group gets a lot of attention. The solution for younger people is to give them what they need–love, kindness and nurturing.

      For adults, research has shown that a hard line needs to be drawn and that bullying will not be tolerated. No love, kindness and nurturing. Adults need to take responsibility for themselves and get their act together on their own time.

      College nursing students are stuck somewhere in between and there is new research being published regarding their unique situation. All of the points you make are valid.

      THANK YOU for reading and I’m so glad you contributed to an ongoing conversation!

  2. I will wholeheartedly agree that bullying begins in the classroom. I graduated in a BSN program in 1991; my pediatrics instructor was a bully…hands-down. She regularly would chastise us and “dressed me down” in front of my peers when she gave us an unanswerable question about IVs — we needed to calculate how many drops per minute for an IV, and she did not give us the “drop factor” for the IV tubing. I asked another instructor about it over lunchtime…that instructor asked HER about it, and I got hauled into a closet and reprimanded for “making her look bad.” This was in front of my classmates in clinical.

    I took her to task for not giving us all of the information needed…where I found that chutzpah…I don’t know to this day. Somehow…she gave me all A’s for that rotation. I think she was afraid of what I’d do. I hated pediatrics from that day on.

    I remember the way I felt…and I made sure when I started teaching, I NEVER made my students feel inferior or bad. I still precept students to this day as a Nurse Practitioner…remembering everything that I’d experienced…and vowing to never do that to anyone. I certainly witnessed more bullying in the nursing field in every job I’ve worked as well.

    Nurses DO “eat their young” at every level. It’s about time this was brought to light. Thank you for sharing.

    • I think that the preceptor role is so important and often managers just throw students or orientees with any nurse who has a pulse. Care must be placed in preparing preceptors for their special role–they can set novice nurses up for failure or they can empower us. This is being addressed in academia (meaning research is being published) but it isn’t getting to the bedside for implementation. That is the next question. What is taking so long for this research to be taken seriously by executives in decision making positions? It has been shown that Magnet hospitals do take preceptor roles more seriously and that there is less bullying in general. I’m going to keep the conversation going and I appreciate you taking part!

    • I am so glad that a(nother) abused nurse friend directed me to this dialog. My experiences as a victim of bullying have so turned me off from the profession of nursing that I have quit for now to write about the problems, which for me, started in nursing school. My book is called FiredUp and the first draft will be completed soon. If and when I return to the medical field, I will address horizontal violence instantly and boldly, and will not back down until I am satisfied by the resolution. I encourage other victims to address each and every insult as if it were happening to a loved one. HV is not your fault. Have a good week. For a change. Sincerely, Beth

      • Hi Beth, thanks for writing. I’ll be on the lookout for FiredUp and am excited about your project. Not excited that bullying was a motivator for you. Write to me when it is published and we’ll put something on the blog about it. I also have a Facebook page ‘Nurse Gail’ and we can post something there. I appreciate you words of wisdom for others. Keep in touch!

  3. This isn’t only a nursing problem. This goes on between techs and between doctors as well as any combination between nurses, techs and docs. I love what I do and love my patients but I really don’t like my work environment. I am one who’s being bullied and I have seen a marked drop in self esteem, confidence and skills compaired to what they were when I graduated 8 years ago.

    • Thanks Cristy for sharing. I’m sorry you are going through this–you are in a tough position. Hospital politics are very complicated. It is so important that you continue to find satisfaction in caring for others while caring for yourself. I too saw my self-esteem take a nosedive while working at the bedside in New York City (Seattle and Austin were fine). Having friends and a life outside of the hospital helped a lot until I was able to shift some things around. It is a truly complicated problem and the solution is multi-pronged and going to take time. I wish that wasn’t the case.

  4. The fact that you think all nurses should have a BSN,is bullying in itself ! Quit your whining and complaining ,come to work and do your job,simple.

    • Oh, the irony.

      • I agree that Nurses should be required to obtain a BSN in order to sit for the NCLEX. Speaking as a former CNA I wouldn’t trust my life to an RN that didn’t have a minium of a BSN! I feel feel that two years of education or less isn’t sufficient enough to prepare a Nurse for the responsibilities and duties of their careers. For example an LPN who graduated in 10 months doesnt have the adequate Psychological knowledge to fully benifit there patients.

        • Christopher, education in nursing is a HOT topic. Anyone with less than a BSN seems to have a strong opinion about it. I’ll post something soon about the topic. Thanks for reading!

  5. Imagine when you are new to the country, trying to settle down- facing challenges like; driving on the opposite side of the road, settling kids to new schools, working as a nurse assistant before you do your NCLEX even though you were a Manager in your country of origin, -and then you come face to face with this animal called Bullying!
    In a way, even though the experience was so traumatic for me, I learnt how to say STOP right NOW! and I now love to empower other nurses facing similar situations.
    People should not be afraid of the ‘nurse-bully.’ They suffer from low self esteem that’s why they do what they do!

    • Especially where I live in NYC the immigrant nurses face so many obstacles. It is truly a challenge and bullying is a complex issue to solve. Empowering others is so important, Joyce. The nursing world is glad to have you!

  6. I couldn’t agree more! I am a senior nursing student at a school where we have a residency program and are set up with a preceptor. I feel as though I am thrown into situations and I suddenly am taking care of 4 Pts instead of 1 like my other rotations. I am scared of making mistakes and I keep telling myself that my preceptor is just trying to help me in the long run, but I feel that she isn’t there to support me, and this transition from student to nurse is hard. It also doesn’t help having professors that all talk to each other instead of helping us through our struggles. My confidence in myself and self esteem levels are so low when I am in that clinical with my preceptor and each week I have to mentally prepare myself for a 12 hour shift and hope that I will one day be a great nurse.

    • I had a friend in nursing school who would get physically sick the night before clinical because it was so bad. I have a great deal of compassion for nursing students. It is important for preceptors to instill confidence in those they mentor. Thank you for sharing your thoughts.

  7. OMG I just started working in that unit and have met mostly everyone in that picture. I’d love to talk to you privately.

  8. I am a nurse for almost 49 years. I am vibrant and active and work part-time. I also hold a CNOR certification. I do not have a B,S.N. I am the oldest nurse chronologically on the unit. I am working with young nurses who hold a college degree. The amount of mistakes I see from these people are astonishing. I have had physician’s say to me they would rather have me around in an emergency than anyone one else. Years of experience count. NOT a paper that states you have completed course work to finish a degree.
    No one has stated what this “bullying” consists of. As Mark stated” go to work, do your job and help your co-workers as needed”. Simple as that!

    • Hi Ellen, thanks for reading. I’m glad you found my website. There is a link to research at the bottom of my post. You can find the definition and examples of bullying there. There is also another link for the Blog Carnival where other nurse writers cover the topic of bullying. Best to you!

  9. Gail,

    I am not a nurse, I am a Physician Assistant. With that said I don’t even know if I have a right to be part of this blog.

    Bullying is a very vague and ill-defined term that is based on one’s personality, previous life experiences and expectations. What could be delegating or giving instructions could be perceived as bullying. Same goes for sarcastic remarks and comments.

    Any unprofessional, abusive, and/or hostile behaviors must be written up and dealt with by management. Being in the union does NOT protect anyone from an official write up that could lead to termination of one’s employment. Talking to colleagues or whining about an “unfair” event will lead nowhere. Pick you battles, though.

    In my opinion education only fractionally effects interpersonal interactions. Job security and management, on the other hand are the key factors when it comes to a team-building especially between full-timers and travelers. Any environment has challenges as interpersonal relationship is a constant variable. Years in service does NOT mean experience. Experience does not mean efficiency. There should be a merit for one’s behavior toward another.

    All the best!!!

    • Nurse Gail is for everyone! Thank you for reading and taking the time to write. You make some very good points. I have worked with a few passive managers who didn’t want to go through the long process of reprimanding employees because it goes beyond a 10 minute meeting in their office. Nurses at union hospitals have the right to request a union rep be present for any such meetings and there are often scheduling conflicts and the union will refute the action based on certain criteria. For the manager, they pick their battles and writing nurses up for bad behavior is low on the priority list when there are pressing budget and policy issues. You are right, complaining about a bad situation creates an overall negative work environment for everyone. I wish there was a Miss (or Mister) Congeniality award (or even better, a RAISE) for positive team players. But nurses are not paid based on merit in a unionized hospital. We are paid only based on years of experience and sometimes there is a very small differential for education. Otherwise, the helpful nurses make the same wage as the dysfunctional ones. Again, you are right, education is only a fraction of the solution. It requires multiple top-down and bottom-up strategies. Again, thank you for your comment.

  10. Gail…interesting topic and all too true. I am a recently retired R.N. The hospital I worked in had education sessions a few years back re: bullying that were mandatory attendance for all staff. Ironically enough the “bully” on our unit did not and does not recognize any of her behaviours and is the first one to accuse others of bullying, especially managers. She is also one of the only nurses on the unit with her BSCN.
    It is my experience from multiple examples that bully’s for the most do not see themselves in that light. I also feel that the term has become used very loosely….a friend who is a charge nurse asked a young nurse to please answer a call light and the nurse refused saying it was not her patient and accused the charge nurse of bullying her. Interesting. Very glad to be retired.

    • Good insight JMF. I see where you are going with the call light example. Someone who doesn’t like another nurse can claim bullying when it isn’t the case at all. The same thing happened when sexual harassment came to light. As with any harassment, bullying needs to be clearly defined in a policy or initiative to prevent or end it. The policy needs to be enforced by management. When management is the bully, well that is another blog post for another time. I am so glad to hear that you are retired and I hope you are enjoying it. As a nurse, you definitely deserve to!

  11. It is ok to address the topic of bullying because it is true that some nurses ” eat their young”… But is it right that you post a picture of the staff you worked with to call them out? I know staff you have worked with and that seems highly inappropriate. We all need to take accountabilty for how we act. Maybe that would fix the problem: if we give each other respect, be confident, be humble, do our job and focus on the patient first. That is how I have been able to make things work as a traveler for over 10 yrs.

    • Thank you for your comment. I’d like to address your issue with my choice of photo for this post. I believe that the photo tells its own unique story. I think that readers can look at the photo and learn something about their own stereotypes of what a bully looks like. The photo appears to be a happy group of nurses and no one would guess what was going on privately. In fact, when some people look at the photo they might assume that I was the bully. People don’t generally perceive me as a minority but on almost every unit I’ve worked in Manhattan, I was the only American born, American educated, English as a first language, Caucasian, blonde nurse. I was an easy target for displaced aggression.

      Only the women in the photo know how they treated me and each other. I did not draw a circle around the bully and call her names. The photo is meant to be provocative and not to “call them out.” Some of the kindest nurses work on that unit and I still keep in touch with several of them.

      However, because professional integrity is very important to me, I thought just to be safe, I should ask around as to the “appropriateness” of the photo. I attend NYU and have access to some of the world’s greatest innovators in healthcare, business and technology. Without giving them the back story, I asked leaders in nursing and health, an expert in social media and a business ethics pro for their opinions. They all agree that the photo is appropriate.

      But that doesn’t mean that your opinion isn’t valid. It is. I appreciate you sharing because it was thought provoking and I learned something from it. I hope you continue to read and comment on the blog.

  12. What about Nurses bullying CNA’s?

    • Thank you for reading Natalie. Managers bullying nurses and nurses bullying CNAs is a whole other issue. It is a valid issue but one that involves a power dynamic that is different from horizontal bullying. It is all so frustrating, isn’t it? Thanks again for reading and commenting.

  13. Hello Gail,
    Thank you for the inspiration and kindness in the way you speak about important issues in the nursing profession. I volunteer at a hospital and see the bullying all the time. I also start my nursing program and hear horrid stories of the instructors. I will continue reading your posts.

    • Thanks for reading NurseGail.com and for YOUR kind words. I think is is very smart of you to volunteer and you are getting a good idea of what is ahead. You might find support in the most unlikely people and you can always reach out here if it becomes too much. My thoughts are with you!

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