by Beth Boynton, RN, MS
At a recent conference I was talking with a colleague about workplace violence. She was adamant in her opinion that, “Psychological bullies must be terminated”. I was and am uneasy about this statement. If/when other interventions fail, I agree with her, but I don’t believe that such a black and white solution is the best way to begin problem-solving an issue that has so much gray. In fact, focusing blame on individuals in the early stages of addressing disruptive behavior may allow us to avoid the systemic aspects of this multi-layered problem.
When it comes to horizontal and vertical violence, we are like the frogs in the boiling frog story. Do you know the one? The temperature is turned up so slowly that the frog gets used to it until it is too hot to react. Many disruptive behaviors on the part of doctors, nurses and others have been going on for a long time. We’ve grown accustomed to poor conduct! Yelling, humiliating, excluding and talking about others behind their backs are common behaviors. That doesn’t make them O.K., but it does shed light on the necessity of changing the cultures we work in.
As we work to establish and maintain safe cultures and respectful workplaces, there are three reasons for using terminology that includes individual and organizational behaviors. Each of these will help to reduce resistance, fear, and confusion about zero tolerance for abuse.
1. Reveals the True Problem
When we use the term ‘bully’ it allows us to blame one person. ‘Bullying’, on the other hand invites us to consider victims, bystanders and culture. Since all of these are part of the history and cause of workplace violence, it makes sense to understand and address these aspects of the problem.
A bully can’t exist without a victim or in an environment that doesn’t tolerate bullying behaviors.
2. Reflection Process is Safer
Looking inward is often a difficult process for many of us and yet an integral part of changing behavior. Consider how these reflective questions might feel:
I wonder if I am bullying the new nurse?
I wonder if my behaviors could be perceived as bullying?
I wonder if I am a bully?
The first and second statements allow us to be human and imperfect and include another person’s perception as part of the picture. The third one is more threatening and defines the very core of our being. If we are going to change these dynamics, doesn’t it make sense that we give ourselves and each other permission to make mistakes?
In so many of our stressful environments, we have to be quick and accurate. A seasoned nurse’s decisive comment and action may be excluding and humiliating to a newer nurse. Our chronic sense of urgency becomes a license for poor conduct.
I know that I have been short-tempered, impatient or frustrated at work. With over 25 years as a nurse, I have rolled my eyes, smirked, or used unfriendly body language. I have also joined in conversations about other professionals behind their backs. At this point in my life and career, even with all the work I have done in communication and emotional intelligence, I am not a perfect communicator. However, I am more able to own my part of a conflict and respect how other’s may be impacted, work to modify my behavior, apologize and forgive myself and others.
3. Bridges to Healing Conversations
As we become safer and more skilled in our reflection process, we will automatically be more prepared to show ownership in a conflict. This is one of the most powerful factors that leads us to productive conflict rather than remaining stuck in a power struggle. It is part of the dance of speaking up assertively and listening respectfully that I am often referring to.
An example might be a new OR nurse who is upset and fighting tears because her preceptor humiliated her in front of the team.
The preceptor who perpetuates the status quo might say:
You are going to have to develop a thick skin if you are going to make it as an OR nurse.
The preceptor who is committed to building a more positive workplace might say:
I think I was pretty rough on you this morning. I could have given you feedback on your set-up without the condescending tone and language I used. What thoughts do you have?
The second example is a great way to build a respectful and collaborative relationship which we know will contribute to safer, more cost-effective care and long-term rewarding careers.
More insight and many resources regarding poor conduct in healthcare and it’s relationship to quality and safety can be found in The Joint Commission’s Sentinel Event Alert, Issue 40: Behaviors that undermine a culture of safety.
You may also find the work of Suffolk Law Professor, David Yamada who hosts a blog called Minding the Workplace and is leading legislative efforts to address workplace bullying to be interesting as well as that of Drs Ruth and Gary Namie, founders of the Workplace Bullying Institute.
Ultimately, as those of us who work in healthcare address disruptive behaviors that arise from stress, lack of awareness, inadequate communication skills, and toxic organizational cultures we will filter out the few remaining individuals who persist in bullying behavior despite feedback and learning opportunities. These are the bullies and yes, they should be terminated!