Nursing Workplace Bullying: Evidence-Based Support, Procedure To Manage The Conflict, And Interventions To Foster Positive Environments

Contributing factors:

Person(s) who saw the Incident or first came to the scene:  I was appointed at cubicle 1 in order to assess the vital signs of a patient. As I saw that the patient was not responding I pushed the emergency call bell and started the CPR, as I thought I could have done this much for saving the life of the patient. But my respected preceptor asked me to step back from the scene in an unacceptable manner in front of Dr. Tim Coloton and RN Anna Roberts. 

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Debriefing is an essential part of our evaluation. Following this incident Jenifer did not invite me in the debrief unlike the other team members.

Action taken / intended, if any, to prevent recurrence of the incident: Yes , a committee was first set to assess the validity of the complaint lodged and serious warnings have been provided to all the members that such an act would not be tolerated..

We have revised the rules of our organisation and have upgraded the punishment .On any further complaint, legal actions might be taken.

We have also arranged for a workshop where we have provided training to stop the prevalence of nurse bullying.

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Describe any longer term action proposed to prevent a recurrence

We will further improve our information system such that it becomes easier for the victim to lodge complaint.

Zero tolerance policy should be made more stringent and severe complaints may also lead to cancellation of the nursing registration.

Were issues related to patient ID or patient factors No, it was not related to any patient.

Were issues related to staffing levels, training or competency? The complaint of bullying was lodged by freshly graduated nurses named Shannon, against her preceptor Jennifer.

Was equipment (or use/lack of use) a factor? (Manager) No

Was the environment a factor? (Manager) Yes, it is the duty of a senior nurse or the nurse in charge to be apprehensive to his/her junior and maintain a respectful ambience.

Were appropriate policies or procedures or lack thereof a factor? (Manager) There were not much procedural deficits, except that there was a lack of monitoring.

Was the failure of a safety mechanism or barrier designed to protect the patient/staff a factor? (Manager) Yes , the safety mechanism has been redesigned regarding the protection of the dignity and the integrity of the nurses.

Strict record keeping, proper information exchange system has been revised.

Was communication a factor? (Manager) Yes communication was a factor. The accused nurses failed to communicate with her juniors and address her concerns.

Like many professions, the profession of nursing also has its share of bullies who are a disgrace to this profession and dishonor the vocation, while the other nurses work with devoted competence and good will. Bullying has a detrimental effect on the ambience of the work place and the other staffs. It can cause low self-esteem and in some cases can make the nurses leave their profession (Spector, Zhou & Che,2014).

This paper aims to analyse the incidence of the nurse bullying that have taken place by evidence based support with relevant literatures , the potential procedures to manage the incidence of the conflict of interest that took place in the case study and the possible interventions to foster a positive environment for the sustainability of the freshly graduated nurses.

Description of the Incident

Szutenbach, (2013) have pointed out the presumed cause of nurse bullying , that is the long term paternalism in health care, the enculturation from the seniors and the perception that bullying is normal . Other causes are that this profession is mainly women centred and the nurses think that they should not be assertive to the junior nurses (Spector et al., 2014). Ariza-Montes,(2013) have proposed some other reasons of nurse bullying such as loss of self-esteem due to repetitive criticism.

Goldberg et al., (2013) have proposed that few tactics of bullying in nursing academia as the withholding information without sharing, gossiping, silencing isolating, acting covertly, sabotaging, physical bullying behaviour, creating trust issues, creating intentional workloads and more.

Spector, Zhou & Che,(2014) have proposed that nurses are often recipient of verbal abuse from their seniors and are unable to lodge proper complaints  because they feared, that  doing so would place them in the danger of dropping their job. It is evident from the case study that Jennifer criticises Shannon for narrating the bookish medical information instead of encouraging her or appreciating her. This kind of a cold behaviour was identified more than once by Shannon. According to Goldberg et al., (2013), bullying often represents as repetitive acts of verbal abuse and criticism, but may often take a more elusive form. Shortly after the recruitment of Jennifer as a preceptor of Shannon, Shannon was handed over with heaps of responsibilities at a go but the preceptor did approach Shannon for the rest of the shift. It is clearly evident that there had been a lack of support from the senior nurse. As a preceptor of a junior nurse Jennifer could have kept a close watch on Shannon at the same time without hampering the autonomy. This could have been done by repeated visits to Shannon and providing positive encouragement as appraisals. Overburdening the target with unnecessary workload is a common tactics of bullying (Szutenbach,2013).

Another instance can be seen from the case study that the when Shannon could correctly answer Jennifer’s question, Jennifer appreciated her but with a pinch of sarcasm added to it. Work place bullying tends to be more sophisticated than physical abuse and involves psychological cruelty. In this case Jennifer might have thought that Shannon would not be able to answer her question hence she would get a chance to humiliate Shannon for her incompetency, but Shannon’s appropriate response to Jennifer’s question made Jenifer more annoyed for missing this chance. While reflecting on this, it is necessary to understand the reason behind such kind of behaviour. This can be due to any past experience of bulling where the same has been confronted with some of the other ways of bullying by her seniors.

The case study reveals the fact that Shannon was not invited by Jennifer during the debrief, where debriefing is an essential part of the nursing decorum. Hence the perception of isolating behaviour is very common in this respect. Inviting the target’s colleague to interactive meetings excluding the target is a clear indication of nurse bullying (Smith  et al., 2016). ( Goldberg et al.(2013), have proposed one of the essential tactics of the bullies are to assign task to the target that keeps him/her away from his / her peers. Social isolation is deniable if cleverly executed, as the bully can cleverly deny having done anything with the intension of causing any harm. Social isolation causes psychological distress in the target and often is the sole cause of nurse’s turnover (Lowenstein, 2013).

Action taken / intended, if any, to prevent recurrence of the incident

Conflict can be considered as an inevitable part of the working environment and hence it is necessary to understand the concept of conflict. Escalation of the conflict may increase if there is an incidence of bullying or horizontal violence or if the newly graduates are not supported by the experienced nurses or the system orientation practice (Spector, Zhou & Che,2014).

The ultimate step of the workplace bullying is conflict of interests occurring between the target and the bully (Goldberg  et al.,2013).  Shannon has been clever to step back when Jennifer asked her rudely to step back and they would be sufficient to handle the adverse situation.

As stated by Ariza-Montes ,(2013) some of the general approaches for conflict resolution involves confrontation with the bullies. In this case Shannon might have confronted Jennifer after the completion of the shift. Compromise might be useful that involves negotiation, swapping and tradeoffs, although this might not be useful in this case. It is to be remembered that resolution and the management of the conflict requires a clear communication and a level of understanding of the perceived areas of disagreement. It can be seen that Shannon has given priority to the clinical condition of the patient rather than confronting Jennifer at that time.

As a member of the team the nurse preceptor Jennifer should be able to work in collaboration with the colleagues for delivering a safe, effective and ethical client care. It is important to indorse a respectful work milieu by the modelling of a skilled behaviour. The newly integrated staffs should be supported and integrated in to practice settings (Thompson, 2013). Jennifer would have approached Shannon in a gentle way and would have explained her about the side effects of resuscitation or the accountability of the nurses. Jennifer might have personal stress that can affect the personal relationship among the nurses but it is necessary to keep the interest of the patient in the frontline and understand that a nurse-nurse conflict may affect the client care.

Szutenbach, (2013) have proposed that educating and preparing the student nurses plays a key role to address the bullying behaviour. The first steps involves the recognition of the behaviour, which in this case study, Shannon has supposedly identified, separating one’s self from bullying , confronting and speaking up.  The nurses should get an extensive training to deal and prevent bullying behaviour (Smith et al., 2016). One of reason that the bullying behaviour continues is that nurse consider the bullying of the other nurses to be a normal custom of the profession. The target should spend some time to observe and confirm the behaviours of the co-workers, whether they are being respectful to the person or others?

Nurses who are repeatedly subjected to criticism develop a sense of insecurities, worthlessness or develop question to their self competence (Szutenbach, 2013). When a nurse is faced with sarcasm or criticism it is essential to take a mental step back and observe the behaviour. It has been found that many bully victim remains silent only to become flustered that they do not leave their unit whereas some leave the profession of nursing. Granstra, (2015) have proposed that victims should speak about the bullying to someone who can be trusted. The peers of the victims should no ahead of time about the bullying incident such that necessary actions can be taken if required.

Longer-term action proposed to prevent a recurrence

Castronovo, Pullizzi & Evans, (2016), have proposed that the solution for the nurse bullying should include an incentive for the institution for implementing the necessary processes and to certify that they are effective. The author has proposed the development of a national standardised measurement tool for measuring the level of nurse bullying at the workplace. The authors have also emphasized on the fact that the results has to be properly documented and reported.

Another proposed intervention is to augment the understanding of the bullying issue among the nurses, administrators and the educators (Thompson, 2013). Educational awareness campaign can be useful in achieving the primary and the prevention against bullying (Smith et al., 2016). It is necessary to provide the nurses with skills and coaching for addressing bullying. Some of the initiatives are the assertiveness and the conflict management.

Lowenstein, (2013), have emphasized on the importance of leadership in mitigating the rates of nurse bullying. Relationship- focused type of leadership is required to lessen the occurrence of bullying. Townsend, (2013), has emphasized in the implementation of the zero tolerance policies to combat with nurse bullying. The suggestion for the implementation of the zero tolerance policy moves beyond the literature. In 2008, the Australian Joint commission had suggested the development of the zero tolerance policy in the hospitals for managing the disruptive behaviour among the nurses.

Other attempts for reducing bullying in nursing involve the introduction of the proper leadership standards to combat the effect of bullying. Hospitals and organisation would have some defined codes of conduct that would be able to define the disruptive or inacceptable demeanour of the nurses.

Another attempt for resolving the issue related to nurse bullying is the provision of applying stringent legislative rules against work place bullying.

There should be a prompt complaint portal that can promptly deliver the complaint lodged by the victims to the appropriate people. Proper legal actions should be taken against the accused in case of nurse bullying.

Nurse bullying can be a serious threat and hence should be addressed seriously, sending a clear message that it should not be tolerated. Proper organisational policies and interventions such as conflict management and effective leadership issues can be helpful in resolving the issue. Timely detection of the issue, proper staff educations and introduction of special incentive schemes for the hospitals abiding by this intervention can be helpful in combating the incidence of the nurse bullying.

References

Ariza-Montes, A., Muniz, N. M., Montero-Simó, M. J., & Araque-Padilla, R. A. (2013). Workplace Bullying among Healthcare Workers. International Journal of Environmental Research and Public Health, 10(8), 3121–3139. https://doi.org/10.3390/ijerph10083121

Castronovo, M. A., Pullizzi, A., & Evans, S. (2016). Nurse bullying: A review and a proposed solution. Nursing outlook, 64(3), 208-214. DOI: https://doi.org/10.1016/j.outlook.2015.11.008

Goldberg, E., Beitz, J., Wieland, D., & Levine, C. (2013). Social bullying in nursing academia. Nurse educator, 38(5), 191-197.doi: 10.1097/NNE.0b013e3182a0e5a0

Granstra, K. (2015). Nurse against nurse: Horizontal bullying in the nursing profession. Journal of healthcare management, 60(4), 249-257. Retrieved from: https://journals.lww.com/jhmonline/Abstract/2015/07000/Nurse_Against_Nurse__Horizontal_Bullying_in_the.6.aspx

Lowenstein, L. F. (2013). Bullying in nursing and ways of dealing with it. Nursing times, 109(11), 22-25. https://europepmc.org/abstract/med/23596771

Flateau-Lux, L. R., & Gravel, T. (2013). Put a stop to bullying new nurses. Nursing2018, 43(6), 24-28. doi: 10.1097/01.NURSE.0000429803.49353.c8

Smith, C. R., Gillespie, G. L., Brown, K. C., & Grubb, P. L. (2016). Seeing Students Squirm: Nursing Students’ Experiences of Bullying Behaviors During Clinical Rotations. The Journal of Nursing Education, 55(9), 505–513. https://doi.org/10.3928/01484834-20160816-04

Spector, P. E., Zhou, Z. E., & Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. International Journal of Nursing Studies, 51(1), 72-84. DOI: https://doi.org/10.1016/j.ijnurstu.2013.01.010

Szutenbach, M. P. (2013). Bullying in nursing: Roots, rationales, and remedies. Journal of Christian Nursing, 30(1), 16-23. doi: 10.1097/CNJ.0b013e318276be28

Thompson, R. (2013). Take action against nurse bullying: strategies for individuals. Medsurg Nursing, 22(6), 403. https://search.proquest.com/openview/7a052d0d8c35ca90f56dfffb2e3a5be8/1?pq-origsite=gscholar&cbl=30764