3 Faces of Bullying Common in Hospital Settings

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Bullying by a patient

An angry young male is admitted to the hospital after he was shot by police during a drug deal. He becomes demanding and treats the nurses like they are his personal servants. One of the nurses finds a tape recorder in his bedside table and spreads the news to the other staff. The nurses are suspicious about why he is taping conversations and fear he will take words out of context and sue them. Pretty soon no one wants to take care of him. Bullying is an offensive, intimidating, malicious or insulting behavior or abuse of power conducted by an individual or group against others, which makes the recipient feel upset, threatened, humiliated, or vulnerable. This undermines self-confidence. Bullying is behavior that is generally persistent, systematic, and ongoing.

Bullying by a physician

An operating room nurse is assigned to work with an orthopaedic surgeon. Before surgery begins, the male nurse tells the male surgeon that he is angry surgeonnot often assigned to orthopaedic cases. After surgery, the male surgeon grabs the front of the nurse’s scrub top with his bloody glove and berates him for his performance. When the nurse asks him to remove his hand, the surgeon sneered, “Are you afraid I am going to hit you?” Bullying is a disruptive form of communication a person perceives to be harsh condemnatory attack upon herself or himself professionally or personally. It includes demeaning comments, intimidating or condescending language or intonation, and issuing threats.

Bullying by colleagues

A nurse is hired as a nursing administrator. Her peer group members are the nursing supervisors. When she sits down to eat lunch with them, she is greeted by silence. She tries to start conversations, which sink like a stone without responses. After she attends an out of state Joint Commission conference, the silence gets worse. This new employee previously got along well with others, but is puzzled by the reception she receives from the nursing supervisors.

Bullying includes silence and social ostracism. All of these are real instances of bullying.

How were they addressed?

Bullying by a patient:  The nurses, with their nursing supervisor, worked out a plan of care to set limits on the angry young man’s behavior. They rotated him to a different nursing unit every month until he could be discharged. He lost his power to intimidate people and modified his behavior. Nurses are educated to develop plans of care to deal with manipulative patients who test the limits. The bullying of this patient kept him in control until the nurses took back their power and developed a unified approach to deal with his behavior.

Bullying by a physician: The operating room nurse reported the surgeon’s behavior to the nursing administration. They explained that the surgeon brought a lot of patients into the hospital and that they could not change him. The male nurse knew two relatives of his were planning to have orthopaedic surgery within the next month. He convinced his relatives to change surgeons and have a different surgeon at a different hospital perform the operations. The nurse’s employer and the surgeon both experienced financial repercussions of the changed surgical plans. The Joint Commission standards require facilities to have policies on how to deal with disruptive behavior. Some facilities have a zero tolerance policy, which means they will tolerate no incidents of disruptive, bullying behavior. In these settings, this orthopaedic surgeon may have been removed from the staff.

Bullying by colleagues: The nursing quality assurance coordinator stopped trying to eat lunch with her colleagues and teamed up with another nursing administrator who was friendly to her. She learned the supervisors were jealous because she was sent on an out of town trip. She never felt there was a good fit between her and the hospital. At the end of a year working at the hospital, the nurse resigned her position and started her own business, Med League Support Services, Inc. Social ostracism and silence are subtler forms of bullying than the abusive, disruptive behavior of the patient or orthopaedic surgeon. Yet they have power to wound and prevent the development of a well-functioning team.

Have you encountered bullying in your career? How did it affect you? How did it get resolved?

Iyer-sm-300x300Patricia Iyer MSN RN LNCC is president of Med League Support Services, Inc. Learn about the CE cruise for nurses in 2015 . See www.patiyer.com/bbb for details.

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13 Responses to 3 Faces of Bullying Common in Hospital Settings

  1. Kathryn says:

    All interesting experiences and comments. I’ve been a nurse in hospitals for 25 years. Nursing…it is cut throat and subtle and blatant, bullying is common. We are bullied by HR, Administration when we are forced to accept patients without proper staffing. We try to achieve professionalism but we undermine ourselves by not working as a team of equals and mentoring our new nurses and caring for each other. It’s very common but not tolerated everywhere . If HR and nursing administration does not support their nurses in these situations of nurse to nurse or nurse to doctor or patient to healthcare member, then that level of disrespect is passed on to all of us and it affects all that we do. Do doctors treat each other this way ? I’ve not seen it. There is a level of disrespect in the nursing profession that’s been there a very long time. This is not professional and supportive behavior and it’s disheartening . It doesn’t matter how many initials after our RN….if we still allow disrespect to each other then how do we move forward? It comes from the top…administration, not believing us or caring about acuities, sick people now that used to be in ICU and confused and disoriented and violent patients, forcing beds over excellent patient care, focusing on $ instead of great patient care, allowing patients to treat us rudely and make impossible demands, focusing on excellent patient care for reimbursement and insurance companies call the shots, yet not providing proper staffing and tools to provide excellent care. This is the tip of the iceburg. Nurses should be asked what we need to make things better, there should be concensus, decisions should not be made without us if they affect our practice. How can we call ourselves professionals when we treat each other with this underlying level of disrespect? So behaviors follow, tolerance is allowed. It’s a vicious cycle. We are always caught in the middle between admin, doctors, patients, interdepartment needs. Our needs are never met. We don’t feel supported. So therefore the frustration comes out in bullying. Our patients come first to us. We come last. Burnout ensues….I know what I can tolerate and what I will accept ..or not now. I still love being a nurse and fully support my colleagues but I’m sick of the disrespect from everywhere and within. So much is expected but so little is given. Nurses are asked over and over to work extra. Nursing and nursing support is the first place that cuts are made when budgets are tight. It’s always been that way only now it’s much worse. Take our nursing assistants, make us draw our labs now, empty trash, take our secretaries, make us pickup our patients in ER and transport them to their tests, leaving our other patients behind. We watch our own tele patients while caring for other patients who may take more time than should be required, distracting us from who and what is most important, help our fresh postops without assistants , running to the kitchen or doing vitals, and yet have to assist everyone to the bath or change beds or run to pharmacy or drop off labs or pickup blood ? This department doesnt do this, that one doesnt do that anymore. So we have to pickup the slack and care for our patients, watch tele and monitor for changes. Really? Don’t talk to me about excellent patient care..not until hospitals give us what we need to give excellent care. We all are caring, great nurses. We need support and nursing a priority. Then you will have excellent patient care and outcomes. It cannot be both ways. It’s time to give back to nursing . My opinion.

    • You make some excellent points, Kathryn and obviously have experience to back them up. It is very sad that we don’t respect each other and are disrespected in so many ways. I do believe developing self respect and demonstrating respect for others is fundamental to change. Of course a leadership commitment to building a culture of safety is essential and IMHO includes an apology for old and hurtful ways, a clear vision, communication and I mean effective communication training like medical improv strategies, and enforcement at all levels. There must be no double standards and no mixed messages. Thank you for sharing your experiences and wisdom. I am glad to hear you still love being a nurse and are able to find the privilege in the work despite the big and chronic problems…Beth.

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  3. Becky Buegel says:

    Interesting article, but I am EXCEEDINGLY dismayed by the response concerning the surgeon’s bullying:

    Bullying by a physician: The operating room nurse reported the surgeon’s behavior to the nursing administration. They explained that the surgeon brought a lot of patients into the hospital and that they could not change him. The male nurse knew two relatives of his were planning to have orthopaedic surgery within the next month. He convinced his relatives to change surgeons and have a different surgeon at a different hospital perform the operations. The nurse’s employer and the surgeon both experienced financial repercussions of the changed surgical plans. The Joint Commission standards require facilities to have policies on how to deal with disruptive behavior. Some facilities have a zero tolerance policy, which means they will tolerate no incidents of disruptive, bullying behavior. In these settings, this orthopaedic surgeon may have been removed from the staff.

    I find it hard to believe that in this day and age that ANY institution can get away with saying the physician/surgeon brought in a lot of business and that the organization couldn’t “change him.” Can we spell HOSTILE WORK ENVIRONMENT? The article said the surgeon grabbed the nurse’s scrub top and left blood on it… I’d call that evidence. I’d be in the HR department so fast it would make their heads spin, and I’d file a hostile work environment complaint against this jerk. Thinking that the “nurse’s employer and surgeon both experienced financial repercussions” because two relatives had changed their plans to have surgery? Spare me! Two patients will not/would not make that much of a financial impact on most organizations.

    This article does a great disservice if it is trying to serve as an example to teach healthcare employees how to handle bullying in the workplace. Bullying by a physician should never be tolerated as it appears to suggest in this article.

    • Orfyn RN says:

      The scenario outlined concerning an OR nurse and an Orthopedic surgeon will resonate with any nurse who has spent time working in an OR. This kind of thing still goes on. The nurse sometimes experiences retaliation for reporting such incedents from physicians or hospital administrators. There are more and more enlightened institutions that do not tolerate such physician behavior. Too often this is because the institution has realized the economic impact of the cost for recruiting and replacing nurses rather than because of any sense of right or wrong. Face it, the real customer of the hospital is not the patient but the physician who admits the patient.

      • A sad but valid point, at least in many cases. I guess some good news lies in the shift towards appropriate behavior regardless of the cause….as long as more and more nurses, consumers, and hopefully some docs and administrators insist on it. There must be some who really do want to do the right thing for the right reason!

    • Reba Boyd says:

      It is so true because I too dealt with it for 4 years. I also dealt with a physician/ 2 cardiologist issue but since they bring in the big bucks and I don’t, I got let go for trying to take a stand against it! Sad sad state of sffairs.

    • Kate says:

      Sadly. bullying by Physicians is not as uncommon as one would hope. I have seen it and had it done to me. I did handle it a bit differently but got almost the exact same response from management. In the end I ended up resigning my position.

      Nurse bullying is even worse. I must admit I felt a huge relief when I left active practice in a hospital setting and started my own business. I still remember, while a student nurse, being taught how to correctly mark an IV bag so that another nurse could not change what I had written. The very implications of that alone are frightening.

      The environment I found myself in was incredibly toxic with nurses sabotaging each other right and left. Rather than be concerned with assisting each other to practice at the very highest levels, it was all about undermining the latest “victim”. To be honest, it was like working with a bunch of high school girls with their pack mentality.

      Sadly, all but 2 of the people I graduated with 15 years ago left nursing within 4 years of graduation and all of them cited the toxic environment as their reason.

      • Hi Kate,
        I’m sorry it took me so long to ‘approve’ and reply. Toxic work cultures are horrible for staff and patients. Wow…your stat about your own graduating class is profound. We train nurses to be highly skilled professionals and then treat them (or we treat each other) horribly. I participated in the orientation of a new grad just last week and she said how she went home practically in tears the first few nights wondering if she had chosen the wrong profession. Now, I don’t think that this transition from academia to practice is necessarily easy or should be without some tension, BUT please, we need to SUPPORT our new nurses w/ realistic caseloads and affirmation of what they were taught, (vs bad habits). Anyways, I hear you! What’s your new business? If it is healthcare related, would you like to introduce it via a blog post for “Confident Voices”?
        In any case, take care and thank you for your comment,
        Beth

  4. vmudgett says:

    You definitely bring up a very crucial issue with nurse bullying. I, along with some of my colleagues are passionate about eradicating this toxic behavior in healthcare. It affects the health and wellbeing of staff, and sadly, it has been shown to have severe repercussions on patient safety. While I don’t particularly love the solutions that were used in these cases, the first step is to recognize the behavior and start standing up to it. Sounds like you were also a victim. I believe strongly that the problem we have right now is that there are many policies about disruptive behavior and bullying, but I agree with my colleague, Renee Thompson, policies don’t change behavior, people do. Nurses and staff who are afraid of retaliation stay silent. Others, like the one in the first instance, speak up and get nowhere as far as support from administration. However, I believe that if we all start calling it out, not normalizing it, not accepting it, and not tolerating it, cultures can and do change. It takes a lot of patience and support, and education.

    • I completely agree. Things are changing with people speaking up, identifying disruptive behavior from every angle, and not tolerating it is happening. Unfortunately, it is excruciatingly slow process and the loss for patients and staff in terms of medical error and workplace violence are immeasurable and inexcusable. As much as policies are an important component of creating a zero tolerance culture, without genuine commitment from leadership, they become a mixed message or double standard. (aka a lie!) It is a fatal flaw when bullying is tolerated despite ‘zero tolerance’ policies. Trust is broken and workplaces are not safe. This article helps to explain why a “No Innocent Bystander” approach can help. http://bit.ly/HFdMQf

  5. Where is the part about patients and relativesbeing bullied by nurses or doctors – this is very common –

    • Good point, Therese! Bullying is everywhere. I think it is systemic in our culture and a common, also tragic way, that we relate to each other! Patricia Evens, in her book, “The Verbally Abusive Resationship” she talks about two realities, one where we have ‘power with’ and one where we have ‘power over’. Her book focuses on intimate relationships, but I think the application of her thinking is far reaching. She is definitely a pioneer of this work and has brilliant insights. http://www.patriciaevans.com/ I think as human beings we are evolving out of an era of aggression and into one of assertiveness.

What are your thoughts?