Do Nurses Eat Their Young? What’s Wrong With Communication in Health Care?
The Workplace Bullying Institute defines Workplace Bullying as repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators that takes one or more of the following forms:
- Verbal abuse
- Offensive conduct/behaviors (including nonverbal) which are threatening, humiliating, or intimidating
- Work interference — sabotage — which prevents work from getting done
Renee Thompson, MSN, RN, CMSRN, nurse, author, educator and advocate for workplace change, is making it her mission to bring nurse bullying to light. In her question “Do nurses eat their young?” she shocks us into awareness of nurse bullying. “I’ll do whatever it takes,” she asserts. “Enough of us who believe in kindness, support and nurturing each other can do it! New nurses (and the rest of us) deserve to work in nurturing supportive environments…Bullying has no place in a profession dedicated to caring and compassion.”
So what is wrong with interpersonal and organizational communication in the health care setting? Bullying. Why is bullying happening? One theory suggests that since nurses are not valued in the workplace they feel powerlessness. This results in bullying behavior. Another points to nursing as a predominantly female profession with a forced hierarchy. In this model, the cause of bullying lies in female competition for prized males.
Despite these notions, or perhaps because of them, Ms. Thompson speculates that medical and nursing school education may start the process. “Doctors and nurses learn separately, then are forced to work together without training. We wouldn’t do that with an All-Star basketball team,” Thompson says. “Respectful communication is a skill that can be learned and it is just as important as clinical knowledge.”
Yet it is missing from the beginning. “Nurse sand doctors don’t learn how to communicate respectfully with each other. Student nurses are not even allowed to speak to doctors when they are learning.” It makes sense. “When members of a team learn together, they learn to respect roles and work together.. all working towards the same goal…patient care.”
Research literature describes nurses “as an occupational group, at considerable risk of violence-related workplace trauma” and recounts experiences of “harassment, bullying, intimidation and assault.”(1)
In her own research for her book, which Ms. Thompson conducted while developing student and new nurse residency programs, she heard horrific stories. In her research she encountered recurring themes. “Students and new nurses are the most vulnerable, but any time you change positions, you are at risk. We are still trying to sabotage, especially when the female is younger, thinner, more beautiful and smarter. While nurses are caring to patients, they can be horrific to each other.”
A study of bullying published in Journal of Professional Nursing in 2009 reveals which departments in hospitals were most likely to have bullying incidents and who were the perpetrators. The medical-surgical and critical care units had the highest frequency of incidents at 23 and 18 % respectively. Bullying incidents occurred within nurses’ first 5 years of employment. Senior nurses were the highest percentage of perpetrators at 24% followed by charge nurses, nurse managers and physicians (8%). This research confirms Ms. Thompson’s observations. “Nurses know we eat our young. Some nurses think it’s good to “toughen up” the new nurses. In reality it’s not. It decreases confidence and competence. “
In fact it seems to be a vicious cycle. Those who are bullied lose their confidence and are more likely to be targeted. Ms. Thompson identifies passive communication styles, like “frequent apologizing, avoiding conflict by keeping quiet, giving others priority” as characteristics of victims. Other characteristics included being of a different gender, race, or from a different location.
Ms. Thompson has witnessed workplace bullying in the nursing profession. The behaviors range from“overt-screaming, yelling and openly criticizing in front of others to covert-sabotage, backstabbing and undermining.” Bullying can be as simple as “being nice to your face, but then complaining about you to other nurses all night” or as complicated as “gathering a “posse” against you.”
A 2006 article in Nurse Inquiry suggests that there may be hidden processes at work causing nurse-to-nurse bullying. The authors propose that health care organizations may actually be maintaining the status quo, recruiting nurses who support a top-down hierarchical structure. Ms. Thompson uses an Italian saying “the fish rots from the head,” to describe her understanding of what is happening. She believes that many organizations rely too heavily on policy to solve bullying. Without a robust program, zero tolerance policies don’t work. “Policies don’t solve problems – people do,” she notes.
Bullying can impact patient care. “Organizations with a high rate of bullying have worse patient outcomes.** Many studies demonstrate bullying prevents nurses from asking for help and calling docs at 3am,” Thompson observes. “I know some nurses who feel they can’t rely on co-workers if they need help for patient.” Nurses who are bullied suffer physical, emotional and mental distress which is disabling, impacting their ability to effectively care for patients. “Bullying is pervasive, destructive and nurses are suffering all over the world. I know because they call me!”
Patients are becoming aware of nurse bullying. They are asking questions about it. “They’re on to us! “ she says. And Ms. Thompson is glad. “Awareness is vital to change. The first step for organizations is awareness. You have to know how bad it is first before you can take action. We get numb to bad behavior, accepting it as normal. Too often we believe what the bully tells us.”
The most powerful intervention to stop bullying, she notes, is for witnesses of bullying to speak up. “We need to teach people how to establish peer-to-peer accountability. A simple way is to just starting naming behavior. ‘You are screaming and yelling at me in front of others.’” Thompson proposes “skill development for managers and strong human resources partnerships.”.
It sounds a lot like personal courage is key. “What you ignore – you condone. It doesn’t matter if the aggression is aimed at you or someone else… Set behavioral expectations. You can’t assume everyone knows what respectful behavior looks like. So spell it out….[It’s true] confronting might not work. But not confronting NEVER works. We have to try.” In speaking up, Renee Thompson has decided to do just that!
For a detailed discussion of this topic, see the transcript of the #hchlitss twitter chat that this summary is based on.
Several chat participants requested seminar information from Renee. Please visit Renee’s seminar information page at http://rtconnections.com/events-2/bullyproofing-communication/ to learn more about her upcoming seminars in:
- Irvine, CA: February 7th and 8th
- Orlando, Fl: March 14th and 15th
- Raleigh, NC: April 24th and 25th
- Atlantic City, NJ: May 22nd and 23rd
If you are interested in reading Renee’s book, Do No Harm both the hard copy and the Amazon kindle version can be accessed at http://rtconnections.com/products/book/
1) Vessey, J., DeMarco, R., Gaffney, D., Budin, W. (2009) Bullying of Staff Registered Nurses in the Workplace: A Preliminary Study for Developing Personal and Organizational Strategies for the Transformation of Hostile to Healthy Workplace Environments Journal of Professional Nursing, 25, (5) , 299-306.
2)Hutchinson, M. Vickers, M. Jackson, D. Wilkes, L. (2006).Workplace bullying in nursing: towards a more critical organisational perspective. Nursing Inquiry 13,( 2), 118–126.
**Aleccia, J. (2008). Hospital bullies take a toll on patient safety. http://www.msnbc.msn.com/id/25594124/ns/health-health_care/t/hospital-bullies-take-toll-patient-safety/#