Addressing Bullying in the Nursing Profession

Wednesday, November 22, 2017

Bullying in nursing is one of the major contributory factors for nurses leaving the profession according to a survey published by RNnetwork - but it is an issue that could easily be addressed.

In 2009, a study published in the Journal of Nursing Administration reported 30% of new nurses left their job within their first year, and 57% of those who remained quit the nursing profession by the end of their second year. More than a quarter of former nurses who contributed to the study (27.4%) said their decision to leave had been attributable to workplace bullying and harassment.

Fast forward almost a decade, and the RNnetwork´s “Portrait of a Modern Nurse” survey reveals a worsening picture of bullying in the nursing profession. More than half of respondents who are considering leaving the nursing professional claim their desire to leave has been influenced by bullying or harassment at work - particularly lateral bullying (nurse-to-nurse bullying).

Various studies have shown more nurses experience bullying from colleagues than do physicians or other healthcare professionals. Some have claimed there is a culture of bullying in the nursing profession in which nurses are verbally abused more frequently by each other than by patients, patients’ families and physicians - all of whom commonly abuse nurses.

What Constitutes Bullying in the Nursing Profession?

The American Nursing Association defines any type of bullying in the nursing profession as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient.” This is quite a broad definition and more detailed definitions of bullying can be found in a survey conducted by the Institute for Safe Medical Practices in 2010 which revealed:

  • 88% of the medical practitioners surveyed encountered bullying via condescending language or voice intonation.
  • 87% said they had been bullied via impatience with questions.
  • 79% felt they had been bullied by a colleague´s reluctance or refusal to answer questions.
  • 48% were subjected to strong verbal abuse.
  • 43% experienced threatening body language.
  • 4% reported being physical abused.

These findings were mirrored a year later in a Research in Nursing & Health survey which revealed the five most common forms of lateral bullying in nursing were nonverbal innuendo (raising of eyebrows, face- making), verbal affront (snide remarks, abrupt responses), undermining activities (turning away, not available), withholding information, and sabotage (deliberately setting up a negative situation).

ANA Initiative has Failed to Resolve the Issue

The increase in bullying in the nursing profession comes despite an anti-bullying initiative launched in 2015 by the American Nursing Association. The initiative´s mission statement stated the nursing profession will not tolerate violence of any kind from any source and that registered nurses and employers must collaborate in order to create a culture of respect.

The American Nursing Association also believes a culture of bullying exists in the nursing profession. The Association has produced a booklet entitled “Bullying in the Workplace: Reversing a Culture” which is primarily aimed at student nurses. The booklet is accompanied by tip cards that show various examples of lateral bullying on one side of the cards, with tips on how to respond to each example on the reverse.

The Association also wants employers to implement evidence-based strategies that prevent workplace bullying and harassment. However, developing evidence-based strategies has not been straightforward due to a lack of evidence. Whereas many nurses are willing to disclose their experiences of bullying to researchers anonymously, few report it at the time or during exit interviews.

The Majority of Bullying Goes Unreported

One of the problems with reporting bullying in the nursing profession is that 91% of the workforce is female. Unless the bullying consists of a discriminatory act against a member of a protected status group, it is not considered to be illegal. Only in Utah, Tennessee and California have workplace bullying laws been enacted that require employers to implement anti-bullying training and enforce anti-bullying policies.

Consequently the International Journal of Nursing Sciences reported in 2016 that 70% of bullying in the nursing profession goes unreported and there has been little momentum to further address the issue. By comparison, OSHA is producing an enforceable patient-on-nurse violence prevention standard after evidence was presented to Congress showing the rate of workplace violence in the healthcare industry is substantially higher than in most other industries (nearly 17,000 patient-on-nurse incidents were reported in 2016).

The seriousness of bullying in the nursing profession should not be underrated. Bullying threatens patients´ safety as well as the mental health of nurses. Nurses are four times more likely to commit suicide than women employed outside the healthcare profession. Bullying affects productivity and - due to the volume of nurses leaving the profession - the U.S. Bureau of Labor Statistics predicts a shortage of 1.05 million nurses by 2022. To put that figure into context, there are approximately 3 million registered nurses currently working in the United States.

Solutions to Combat Bullying in the Nursing Profession

Many nurses - particularly those new to the profession - find it difficult to speak openly and freely about bullying because of potential negative personal and professional ramifications. Due to the nature of lateral bullying, many instances of bullying in the nursing professional are a my-word-against-their-word scenario, which less experienced nurses may not feel confident about reporting.

Various solutions have been suggested to combat the culture of bullying, including anonymous report forms and a non-management peer counsel committee. It has not been explained how anonymous report forms could be actioned or what powers would be given to peer counsel committees, and potentially a more practical solution could be anonymous text apps similar to those given to students to report bullying and cyberbullying.

In some schools, the ability to anonymously text reports of bullying has resulted in incidents of bullying falling by 50%. Obviously anonymous reporting has not resolved the issue completely; but, if bullying in the nursing profession were to decline by 50%, it would have a positive impact on patient safety, nurses´ mental health and productivity; and eliminate the potential shortfall of nurses needed to keep our hospitals and medical centers running in the future.