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Bullying: A Hidden Virus in Healthcare

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Numerous studies show the negative impact bullying and incivility have on individuals, healthcare organizations, and patients. Just like a virus, bullying and incivility spread, leaving pain and suffering along their path.

  • Rosentein and O’Daniel reported 71% of nurses and physicians surveyed said there was a significant link between disruptive behaviors of professionals and medical errors. 27% believe incivility lead to a patient’s death.
  • In an American Nurse Today survey, 59% said a patient verbally assaulted them.  In 2016, an ANA Risk Assessment showed 1 out of every 4 nurses was physically assaulted.
  • A study reported in Policy, Politics & Nursing Practice revealed that an estimated 17.5 % of newly licensed RNs leave their first nursing job within the first year, and one in three (33.5%) leave within two years.

If you’re working in an organization where disruptive behaviors are ignored, you don’t need studies or statistics to validate that bad things happen as a result. You know this.

Impact to patients

Disruptive behaviors lead to increased stress and decreased concentration, which impacts patient safety. When employees are uncomfortable communicating with each other, it stops the flow of information. When people don’t feel comfortable speaking up, patients suffer the consequence.

A nurse was concerned about her patient but chose not to call the physician on call because the last time she called her, the physician berated her. The patient extended her stroke and had to be transferred to the ICU.

Impact to employees

Employees pay the price for bullying with their physical, mental, emotional, and spiritual health. Many suffer from PTSD and are no longer able to work because of bullying. Those who manage to stay in toxic environments have decreased motivation and energy at work.

A nurse, Neka, spoke up about a colleague, Adrian, who was bullying new nurses. After an investigation that validated the behaviors, Adrian got fired. The staff put plastic rats on Neka’s chair and on her locker. They excluded her and made her life so miserable that after 3 months; Neka quit and had to seek counseling.

Make no mistake about it. Bullying leaves nasty scars on targets, and time doesn’t always make it better.

However, despite the many studies validating that bullying and incivility are the cause of turnover, related costs, and poor patient outcomes, according to Gary Namie from the Workplace Bullying Institute, only 6% of leaders have identified bullying and incivility as a top priority. Yet 90% say bullying and civility is a problem in their organization.

Why aren’t healthcare leaders making eliminating disruptive behaviors their number one priority?

We need to do a better job.

Good news!

The good news is that bullying and incivility in healthcare are finally getting attention from regulatory agencies.  In April of 2018, The Joint Commission (TJC) released a Sentinel Event Alert that includes shocking statistics about workplace violence in healthcare and recommendations for organizations to act.   

In October of 2017, The Magnet® Recognition program added criteria for Magnet® designation regarding addressing physical and verbal violence. EP15EO requires organizations seeking Magnet® designation to show robust data and interventions regarding workplace violence, bullying, and incivility towards nurses.

The American Nurses Association (ANA) gathered expert nurses to discuss and develop a position statement regarding disruptive behaviors. In 2015 the ANA released a position statement on bullying, incivility, and workplace violence. In their statement, they include intervention recommendations for employers and employees.

While these recommendations and requirements provide organizations with the “what to,” we are still not taking enough action to stop the tsunami of disruptive behaviors.

A healthcare executive hosted a mandatory meeting with all the organization’s front line leaders, 80 in total. During this meeting, the executive shared results from their recent surveys, which showed high turnover due to bullying and incivility. He told everyone at that meeting, “Starting today, you’re going to start holding your employees accountable for their behavior. Go take care of it,” and then left the meeting.

As you might have predicted, two years after the executive’s charge, that organization reached out to me for help because nothing had changed. They were still losing good people because of bullying.

It’s unfair to say, “Start holding your people accountable” without teaching leaders HOW to actually do that. That’s our job and passion. At the Healthy Workforce Institute, we teach leaders how to set behavioral expectations and hold employees accountable for professional behavior. 

The cure for the bullying and incivility virus is to equip front line leaders with the tools and skills they need to cultivate a healthy, professional, and supportive workforce by eradicating workplace bullying and incivility.

Just like the a virus, you need a treatment and a vaccine (let’s hope they get the cure soon!).

We are hemorrhaging nurses to bullying and incivility and putting our patients at risk.

A culture of silence must be replaced by a culture of safety.


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