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.
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.
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.