Bullying in the Workplace in Nursing

Introduction

Everybody should enjoy the freedom of working in a safe, comfortable, and friendly environment (Australian Council of Trade Unions, 2013). However, bullying incidents are inevitable when many groups of people work together (Australian Council of Trade Unions, 2013). This is true for nurses because their jobs involve complex social and political relationships that make them accountable to different groups of people. Indeed, Gallagher & Underhill (2012) say many people acknowledge the hectic nature of nursing roles and the existing constraints that prevent nurses from delivering quality healthcare services. Since women numerically dominate the nursing profession, bullying in the profession has a gender and socialist dynamic (Bryant, Buttigieg, & Hanley, 2009). Gallagher & Underhill (2012) say these dynamics explain why many nurses do not report bullying incidents. Furthermore, many scholars agree that many bullying incidents come from a top-down managerial structure that makes them acceptable in an institution (Australian Council of Trade Unions, 2013).

A recent longitudinal study conducted by the Queensland Nurses and Midwives Council showed that many nurses experience different types of bullying incidents that manifest in violent and aggressive behaviors (Queensland Nurses Union, 2012). For example, the Council says that almost half the number of nurses sampled in the study had experienced some form of bullying in the workplace (Queensland Nurses Union, 2012). The following graph shows the sector distributions of violent behaviors within the nursing profession

Incidence of Workplace Bullying
Figure One: Incidence of Workplace Bullying (Source: Queensland Nurses Union, 2012).

The graph above shows how different groups of nurses responded when the researchers asked them if they had experienced bullying. The same study (highlighted above) showed that clients, patients, and colleagues are the main perpetrators of bullying (Queensland Nurses Union, 2012). Since nursing is care-based, it is paradoxical that bullying exists within the profession. Based on this fact, this paper investigates the intricacies surrounding bullying in the workplace. Particularly, it highlights its impact (on workers and organizations), the rights and responsibilities of employers and employees to bullying, and the institutional responses to bullying. However, before exploring these issues deeper, first, this paper defines bullying and examines its features.

Definition

The Australian Nursing Federation (2013) says many nurses experience bullying through different irrational behaviors from their superiors or colleagues. It also says that such behaviors may cause psychological or physical harm to their victims (Australian Nursing Federation, 2013). The Australian Government adopts a similar definition of bullying by highlighting it as, “repeated unreasonable behavior that could reasonably be humiliating, intimidating, threatening or demeaning to a person, or group of persons, which creates a risk to health and safety” (Comcare, 2012, p. 4). Comparatively, the Australian Human Rights Commission (2014) says

“Bullying is when people repeatedly and intentionally use words or actions against someone or a group of people to cause distress and risk to their wellbeing. These actions are usually done by people who have more influence or power over someone else, or who want to make someone else feel less powerful or helpless” (p. 1).

Although the following section of this report shows the features of bullying, it is important to understand that bullying often occurs because of unreasonable behavior.

Features

Bullying has many dynamic features. For example, victims can experience it from a group of people, or one person. The Australian Nursing Federation (2013) also says bullying may manifest in “indirect, unintentional, physical, or psychological” (p. 3) behaviors. Similar to its nature, the effects of bullying are also dynamic because it can cause physical or psychological symptoms to its victims.

Common Categories of Bullying

The Australian Department of Education and Early Childhood Development (2013) says different types of bullying may manifest in the nursing profession. They include personal attacks, threats to professional status, work-related harassment, and spreading rumors.

Personal Attacks

Victims of bullying often experience different types of personal attacks. For example, many victims of bullying experience such attacks through vilification (The Australian Department of Education and Early Childhood Development, 2013). Such acts may occur in different forms, including racism and sexual harassment. For example, immigrant nurses are often the biggest victims of racism (Lowenstein, 2013). Lowenstein (2013) believes this type of attack exists because some people abuse their powers in the workplace. Victims of racism often develop psychological distress symptoms that may significantly affect their productivity. Similarly, since, numerically, many nurses are female; sexual harassment is also a common type of bullying behavior within the profession. Lowenstein (2013) did a study to investigate the prevalence rates of sexual harassment among nurses and observed that 4% of the professionals often experience this type of harassment.

Threats to Professional Status

Some supervisors and people in authority often bully their colleagues by threatening their professional status. For example, they may undermine the work of their colleagues, belittle their contributions, or humiliate them, publicly. These types of bullying may occur in different forms, including requiring workers to complete duties that are below their levels of specialization, requiring nurses to do unpleasant tasks, or removing them from their positions without proper consultations (The Australian Department of Education and Early Childhood Development, 2013).

Work-related Harassment

Work-related harassment is a common type of bullying behavior. However, allocating unmanageable workloads to employees is more common among victims who experience this type of bullying. The Australian Council of Trade Unions (2013) says this type of bullying often affects the self-esteem of the victims. Moreover, it causes the highest rates of resignations in the professions, because the nurses have either to resign or comply with the “unbearable” working conditions (Australian Council of Trade Unions, 2013). Unwarranted criticism also occurs as a common form of work-related harassment. Perpetrators of the offense often want to undermine their colleagues’ work without any basis. The effects of this type of bullying often manifest as the effects of unmanageable workloads on nurses (Australian Council of Trade Unions, 2013).

Spreading Rumors

Malicious gossip, innuendo, and sarcasm are often common types of practices that most bullies use to spread gossip about their colleagues in the workplace. This type of bullying has many effects, but, broadly, it causes reputation damage to its victims. Broadly, the above-mentioned types of bullying represent different types of nurse-to-nurse bullying. Evidence shows that nurse-to-nurse bullying is the most serious type of bullying because it causes the most severe emotional upsets to its victims (The Australian Department of Education and Early Childhood Development, 2013). Various issues may explain the high prevalence of intra-staff bullying. For example, Gallagher & Underhill (2012) say because many nurses are caregivers, they often prioritize patients’ needs before their needs. Comparatively, The Australian Department of Education and Early Childhood Development (2013) believes that bullying within the nursing profession is a “learned behavior,” as opposed to a personal behavioral problem.

What are the Effects of Bullying?

Impact on the Worker

Bullying significantly affects worker well-being. For example, Comcare (2012) says bullying and work-related stress account for more than half of all worker absenteeism cases. Similarly, bullying may cause physical injuries to victims. For example, an Australian study showed that close to 40% of 762 workers (sampled in the study) highlighted bullying and work-related stress as the main causes of workplace injuries (Comcare, 2012). This statistic shows that bullying accounts for time losses and huge health care bills. A Canadian study also showed the negative effects of bullying on nurses by saying it affects their morale and job satisfaction (Gallagher & Underhill, 2012). Moreover, it showed that its effects on employees also spread to those who witness the bullying incidents (Gallagher & Underhill, 2012). Such observations may cause them to look for better places to work (high employee turnover). Although the above effects of bullying seem broad, Comcare (2012) says different workers respond to bullying differently. Furthermore, it says the act affects both the victims and their colleagues. The Australian Government says, “Distress, anxiety, panic attacks or sleep disturbance” (Comcare, 2012, p. 6) are the main effects of bullying. However, some employees may show signs of impaired judgment, or inability to make decisions (because of bullying). Comprehensively, bullying causes negative job-related outcomes for the employees.

Impact on the Organization

The 2010 Productivity Commission of Australia said bullying significantly affects an organization’s finances (Nurses and Midwives Association, 2014). It is said that bullies costs organizations up to $36 billion annually (Nurses and Midwives’ Association, 2014). Bullying incidents also affect organizational productivity because of poor employee performance. Therefore, some main effects of bullying on organizational performances stem from the effects of bullying on employees. For example, this paper has shown that bullying causes employee absenteeism. This effect comes at a huge cost to organizations because absentee employees are often unproductive employees. Relative to this observation, the Nurses and Midwives’ Association (2014) says many organizations also suffer from high staff turnover. Bullying also leads to high legal and compensation costs to organizations, if the victims resort to legal redress. Some organizations incur the same costs through early retirement costs for employees who choose to leave an organization prematurely (Australian Council of Trade Unions, 2013).

What are the Rights and Responsibilities of the Employer and Employees?

The Australian law requires employees and employers to abide by different laws that create a safe and productive workplace environment.

Employers

The Australian Government says employers have a duty to protect their employees from bullying. It articulates this responsibility through the Occupational Health and Safety (OHS) Act 1991 (Comcare, 2012). The Act outlines employers’ responsibilities to find threats (bullying is one of them) that would affect employee safety and health in the workplace. The Act requires them to formulate measures for eliminating, or minimizing, the risks of such environmental factors on employee well-being. For example, OHS emphasizes the need for employers to formulate policies and procedures for preventing bullying (WorkSafe Victoria, 2012). This measure would make sure employers consistently set rules for managing bullying incidents in the workplace. Mainly, this recommendation highlights the need for employers to enforce a clear set of behavioral standards for all employees in the workplace to abide by (Australian Council of Trade Unions, 2013). These standards should show, clearly, that bullying incidents in the workplace are intolerable. The Australian Nursing Federation (2013) has adopted these standards by saying bullying in the workplace is unacceptable and intolerable. Furthermore, similar to the stipulations of the OHS Act, the Federation agrees that all nurses and midwives should protect their colleagues from bullying (Australian Nursing Federation, 2013).

The OHS Act highlights standards that outline the consequences of bullying. For example, the OHS Act says employers have a duty to consult with employees (especially those that are susceptible to bullying) about the best ways to make the workplace a better and safe environment for all (WorkSafe Victoria, 2012). Mainly, the OHS Act requires employers to consult with their employees on two issues: how to lower business risks and how to formulate policies for improving workplace safety. WorkSafe Victoria (2012) believes these consultations are important in minimizing bullying incidents in the workplace because they raise awareness about the offense. The Australian Nursing Federation (2013) concurs with this fact and says all employers should have a written set of organizational policies about bullying. Similar to the OHS Act, it requires employers to consult with employees when formulating these protocols. Indeed, it is the policy of the Australian Nursing Federation (2013) that all employers “develop (in consultation with employees and Health and Safety Committees) specific rules for managing reported instances of bullying, including independent external review processes” (p. 2).

The OHS Act also says employers have a duty to train their employees about the policies that concern workplace bullying (WorkSafe Victoria, 2012). This exercise should inform employees about the workplace policies on bullying. Similarly, from the training, workers should know the guidelines for reporting, or managing, bullying incidents. WorkSafe Victoria (2012) says people who have heightened responsibilities in managing workplace bullying (such as investigators, registered nurses, and employee representatives) should have specialized training. This training should help them to learn how to manage bullying incidents and when to intervene in workplace conflicts.

Comprehensively, WorkSafe Victoria (2012) says,

“Employers have a duty under the OHS Act to provide and maintain for its employees, so far as is reasonably practicable, a working environment that is safe and without risks to health. This includes providing and maintaining systems of work that are, so far as is reasonably practicable, safe and without risks to health” (p. 3).

Employees

The OHS law requires employees to take reasonable care of their health and safety in the workplace (WorkSafe Victoria, 2012). They should also make sure that their colleagues are not predisposed to bullying incidents. Particularly, since the OHS law requires employers to eliminate, or lower, environmental risks on employees’ safety and health, the same law requires employees to cooperate with their employers and comply with the existing legislation on bullying (WorkSafe Victoria, 2012). Relative to this need, the Australian Nursing Federation (2013) says, “Nurses and midwives are obligated to follow policies and rules concerning health and safety, including aspects of bullying” (p. 3). The Australian Nursing Federation (2013) also says employees should document all bullying and harassment incidents. The federation also encourages all nurses and midwives to report such incidents to their employers (Australian Nursing Federation, 2013). Particularly, it reminds employees to include the names of any persons that may have seen the incidents. Broadly, the OHS Act and the Australian Nursing Federation (2013) say employees should take reasonable care for their safety and health in the workplace. They also require employees to protect their colleagues from bullying (Australian Nursing Federation, 2013).

Processes in Response to Bullying

The government and employers have responded differently to bullying in the workplace. This paper has already explained some of the measures adopted by the government in this paper. Employers also have similar responses in their organizations (organizational rules and protocols on bullying). These policies often vary across different organizations. However, many organizations try to prevent bullying through induction seminars and awareness sessions that raise awareness about bullying incidents in the workplace. Company codes of conduct also explain the rules that govern incident reporting of bullying behaviors and the punishments that all bullies face. Occasionally, employers outline the procedures for managing bullying in employment agreements (Australian Nursing Federation, 2013).

Conclusion

This paper sought to explore how bullying affects the nursing profession and the ramifications that exist for curbing its incidence. Evidence shows that many nurses experience different types of bullying that may manifest as work-related harassment, threats to professional status, personal attacks, and rumor-spreading. These vices have many negative job-related outcomes for employers and employees. The law outlines different responsibilities for employers and employees to lower, or eliminate bullying incidents. Most of them involve policy recommendations that outline behavioral standards for both groups of professionals. While it is idealistic to assume that such procedures will end all types of bullying behaviors, they will lower their incidences.

Incident Report

Nature/Type of Incident/Event:
(Worker)
On 29/03/2014 (8:00 am), I went to check on one male patient, in cubicle one. I wanted to do a set of vital tests on him because he was suffering from pneumonia. I called him by name, but he failed to respond. To see if he could react to physical stimuli, I squeezed his right shoulder (trapezium squeeze), but he failed to react as well. I pushed the emergency call-bell and checked for visible debris by turning his head, slightly, to the right. Using the head tilt chin lift maneuver, I opened the patient’s mouth and inserted an oropharyngealairway. After undertaking this procedure, I looked out for abdominal movements or signs of breathing from the nose and mouth; there were none. I applied a non-rebreather mask and started oxygenation at 12 L/min. Later, I placed my right hand at the center of his chest, and my left hand on top of it. I started compressions. Immediately, Anna Roberts, the registered nurse, dashed into the room and asked me what had happened. While explaining the events that happened, my preceptor, Elizabeth McGreggor, and other medical and nursing personnel, walked in. In an audible, aggressive, and accusatory tone, my preceptor shouted, “Oh my God! What have you done?” She ordered me to get out and said they would “handle it” from there. I left the cubicle.
Description of the incident:
(Worker)
The events that happened in cubicle one were not an isolated incident because on 27/03/2014, at 08:00 am (on my first day at the Emergency Department), after introducing herself, my preceptor never approached me throughout my shift. Similarly, on my second day at the department, on 28/03/2014, at 08:00 am, at the morning handover, she told the team leader that she was “stuck with me,” almost to imply that she did not want to work with me. Similarly, during the same day, she asked me where to look for signs of bleeding from a leukemia patient admitted in holding room one. When I explained that the gums and mucous membranes would be the first places to look for bleeding, she said, “What are you, a walking textbook?” When we examined a different patient, in a different holding room, she asked me “Can you recite what you know about croup?” Before I could answer, she said, “No, do not worry about that, just go in and make sure the parents have some breakfast. We will get the family up to speed as soon as possible.” These incidents show that Elizabeth McGreggor has been overly hostile to me.
Brief description of injury/illness:
(Worker)
Anxiety: I felt deeply distressed by how my preceptor spoke to me in front of the nurses and doctors responding to the emergency call. The incident made me anxious about interacting with my preceptor and colleagues.
Depression: How my preceptor managed the emergency incident at cubicle one made me depressed because it affected my thoughts, feelings, and behaviors at work. Particularly, it made me feel unwanted.
Low Self-Esteem: Based on the hostile treatment given to me by my preceptor, I started to doubt my skills and competencies as a nurse. Since my preceptor often treated me harshly, my confidence as a nurse declined as well. This made me have low self-esteem.
Did the person receive treatment following the injury/illness:
(Worker)
I did not receive any treatment
Person(s) who saw the Incident or first came to the Scene:
(Worker)
Two registered nurses, Anna Roberts and John Matthews saw the incident at holding room one. Similarly, Dr. Jenny Coloton and Dr. Tim Burns also saw it all happen. They did not help me.

References

Australian Council of Trade Unions. (2013). Unsafe Work and Bullying. Australian Council of Trade Unions, Web.

Australian Human Rights Commission. (2014). What is Bullying? Violence, Harassment and Bullying Fact sheet. Australian Human Rights Commission, Web.

Australian Nursing Federation. (2013). Bullying In the Workplace. Australian Nursing Federation, Web.

Bryant, M., Buttigieg, D., & Hanley, G. (2009). Poor Bullying Prevention And Employee Health: Some Implications. International Journal of Workplace Health Management, 2(1), 48 – 62. Web.

Comcare. (2012). Bullying At Work: A Guide for Employees. Australian Government, Web.

Gallagher, C., & Underhill, E. (2012). Managing Work Health and Safety: Recent Developments and Future Directions. Asia Pacific Journal of Human Resources, 50(1), 227–244. Web.

Lowenstein, L. F. (2013). Bullying In Nursing and Ways of Dealing with It. Nursing Times, 109(11), 22-25. Web.

Nurses and Midwives’ Association. (2014). Are You Being Bullied? Australian Nurses and Midwives’ Association, Web.

Queensland Nurses Union. (2012). Inquiry into Workplace Bullying. Queensland Nurses Union, Web.

The Australian Department of Education and Early Childhood Development. (2013). Workplace Bullying. State Government of Victoria, Web.

WorkSafe Victoria. (2012). Workplace Bullying – Prevention and Response. State Government of Victoria, Web.