In June 2021, I was honored to speak at the virtual WOCNext National Conference on the topic of workplace or social bullying in clinical practice and academia. I was stunned to look at my subsequent evaluations, not because they were poor but because they were so lengthy (the most I have ever received in my speaking experience). Over 500 respondents commented about the dire necessity for the information because they were experiencing it, that workplace bullying needed to be addressed, and that the phenomenon was affecting their clinical practice and patient/personal well-being.
More recently, I attended a regional nursing conference and happened to sit at a table where occupants were discussing how workplace bullying was "alive and well." In talking to these clinicians, I discovered that these WOC specialist nurses were being bullied by RN staff, selected WOC colleagues, advanced practice nurses, other providers, families, and even some patients. Why is this bullying occurring? While the COVID-19 pandemic has increased stress levels, can the situation be blamed entirely on COVID effects? I don't think so. Sadly, Meissner1 lamented the phenomenon of workplace bullying as nurses "eating their young" back in 1999. I decided to write about workplace bullying because it reverberates with me. Did I mention that I was bullied as a young nurse educator to the point where I was contemplating leaving teaching and nursing? The experience has haunted me and compels me to comment on what is occurring.
To address workplace bullying, it helps to know a little background about the problem. Bullying is not incivility, though they are sometimes mistakenly used interchangeably and do have some similarities. Bullying is characterized by 2 critical components: a power differential and persistence over time.2 Bullies can control one's work life and can actively cause mental and/or physical health problems in recipients (the literature calls them victims).
In terms of clinical workplace bullying, adverse patient outcomes and work disengagement can occur, so patient safety is threatened.3 Workplace bullying in nursing has been termed "a silent epidemic" and "wall of silence." Notably, workplace bullying occurs across the health disciplines including medicine.4 So why is it necessary to target this noxious phenomenon? Because it continues unabated, good clinicians leave bully organizations (and sometimes their careers), and patient care quality erodes!
An important aspect of background knowledge is understanding that there is no legal protection against workplace bullying in the United States. While many European, especially the Scandinavian, countries list this area as being protected like racial, ethnic, and sexual orientation categories, that is not the case in North America.5 This does not mean clinicians are totally unprotected as professional societies like the American Nurses Association and the critical care nursing organizations have extensive resources targeting workplace bullying.
Because of my own lived experience and my subsequent scholarship in workplace bullying, I wanted to share some strategies to assess and manage this deleterious situation. When one is working in an environment that is negative and stressful, an initial step is to educate one's self about bullying versus incivility and to assess what is happening. (This may be challenging initially because you may feel like you are shell-shocked; if persistent, it may feel like posttraumatic stress disorder [PTSD]). Is this incivility or bullying? Is there two-way communication occurring? Or, are you getting consistently talked AT only? Are you experiencing adverse physical and psychological effects, and are you dreading going to work? Are your leaders ethical and supportive? Or, is your manager or leader the bully? Of note, most bullying activity is from persons in leadership positions towards subordinates.2,4
An important thing to do is to establish psychological safety. This outcome can be accomplished by obtaining peer support. In my own case, my faculty colleagues bolstered my self-confidence and helped ward off attacks by the bully (which even occurred in public meetings). This critical support helped me continue in my position and keep my sanity and career.
Another approach is to seek help from Human Resources (HR). However, a crucial caveat is that the bullying may increase once the bully knows about the report, and the only result may be that your complaint is documented. Notably, research supports that HR departments are not effective in managing bullying, especially when bullies are leaders within the system.2,4 Remember, HR represents the organization's needs and not necessarily your perspectives. Conversely, multiple documented complaints can act to create a pattern that warrants higher-level administrative intervention about the bully leader.
Teamwork can be "dream work" in overcoming bully environments. When people like WOC nurses are working in effective teams, bullying is not as strong or noxious. Witnessed negative events can have a positive supportive group response for targets. Shared expectations of not tolerating bullying can be powerful to diminish it and create safety for victims and witnesses.
Open communication and ethical leadership are crucial to eliminating bullying. Discussing bullying openly by not focusing on individuals but focusing on management of bullying incidents is effective. Anonymous examples can be collated by the work team to discuss "How can this be dealt with?" The approach also allows for a critical discussion about nonresponsive behaviors. Nurse managers, RNs, and other colleagues who are passive and silent when they witness bullying are accomplices to the problem.
Open communication allows for leaders and staff to discuss the realities of the stresses of management in health care. Leaders can bully staff, but staff can bully leaders and colleagues. In one unit where I consulted for WOC care, personnel were rarely helpful and sometimes outright uncivil. In working with the team addressing the problem, staff were required to work with the WOC staff across the hospital. The most problematic staff were purposely selected first. When they learned the demands of the WOC role, assistance from unit members started to improve.
When I was being bullied, a faculty colleague reminded me that the pen is mightier than the sword. The colleague suggested that my horrific experience could fuel future scholarship. I became determined to help improve the situation in academia and cocreated a de novo instrument for measuring academic bullying and tested it with nurse educators and health sciences faculty.2,4 Globally, it is the only available scale designed purposely to measure academic bullying.
The information that I accessed to generate and test this instrument was fascinating, and I learned that workplace bullying is occurring in health care across the planet. My "bibliotherapy" helped me better understand my past experiences, to reframe them, and how to help prevent workplace bullying in clinical and academic areas.
Another aspect of workplace bullying is the opportunity to reflect on your own leadership style. When you are leading, are you listening? Are you communicating in a two-way manner? I have found reflection on lived experience and the use of humor have helped me in leadership activities. Remember most bullies are in leadership positions and may be expert clinicians or educators but not necessarily well prepared for leadership. Workplace bullying must be discussed openly when it is a problem where you are employed. If ignored, the stakes are high. Good clinicians and educators leave bully organizations, and patients' and students' well-being suffers.
Another strategy for ongoing bullying may be upsetting to contemplate but sometimes is necessary. You may be required to "draw a mental line" and make the decision to leave. I made this choice and am glad to share that the results were great. I found a new, supportive environment where patient safety, clinical excellence, and quality education were valued and employees were nurtured. You may disagree, but I found the decision to leave so beneficial.
I hope this View From Here has offered some helpful insights. I hope it serves as a call to action, that is, to highlight the need to address and eliminate workplace bullying. If you are being bullied currently or have experienced it in the past and have lessons learned, please write a Letter to the Editor and share your experiences. My goal here is to promote healthy workplaces, patient safety, optimal WOC care, and a happier, healthier YOU. And that sounds good for the post-COVID world in which we all practice.
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