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Bullying in Nursing School? How Students Describe Their Reactions Renee Buonaguro Volume 42, No. 2 • Fall 2020 Bullying in Nursing School? How Students Describe Their Reactions Renee Buonaguro ullying is a vicious process that has gained momentum as an area of afflicts students in many settings interest since that time (Karatas et al., B from home and online, to school 2017). Cox (1987) identified verbal abuse and in the community. It is a direct func- within nursing and its negative impact to tion of social or physical power differen- the profession. tials manifested through toxic relation- Bullying could be covert, overt, hori- ships between and among students and zontal violence, lateral violence, relation others in their social worlds. It can occur aggression, or mobbing (Caristo & in any setting but is troubling when it is Clements, 2019). Overt bullying is easy to identified in the workplaces related to recognize, the perpetrator is generally nursing professionals and, even more aggressive and others may or may not be troubling, when it occurs insidiously in aware. Covert is more difficult to observe nursing education. It is often overlooked Renee Buonaguro, PhD, RN and includes passive-aggressive behav- as a threat to the nursing profession and iors, eyerolling, and withholding informa- reduced to a belief that bullying is a ‘rite tion (Edmonson & Zelonka, 2019). Another of passage’ (Birks et al., 2018). area for bullying to occur is through digital Although definitions vary from source to Bullying within the nursing profes- media including social media, text mes- source, most agree that an act is defined sion occurs in the United States and sages, and online forums. Whatever the as bullying when: internationally (Difazio et al., 2019; platform, the impact could be devastating • the behavior hurts, humiliates, or Vessey et al., 2009; Yokoyama et al., – especially for nursing students and nurs- harms another person physically 2016). In addition, it is well documented es new to the profession. or emotionally, and that bullying occurs in the United States Nurse bullying does not occur in a • those targeted by the behavior and internationally within nursing vacuum and it is well documented new have difficulty stopping the action schools (Birks et al., 2018; Bowllan, 2015; nursing graduates experience the conse- directed at them, and struggle to Burkley, 2018; Clarke et al., 2012; Karatas quences. It is estimated 43% of newly defend themselves, and et al., 2017). The impact of bullying is licensed nurses leave their first job within • there is also a real or perceived linked to patient safety, psychosocial con- 3 years and 17.5% resign within the first “imbalance of power,” which is ditions, physical problems, and con- year of work (Kovner et al., 2014). In addi- described as when the student tributes to a systemic toxic environment tion, this impacts institutions financially as with the bullying behavior has (Houck & Colbert, 2017). It is estimated, well. It is estimated turnover costs are as more “power,” either physically, during nursing school, 89% of students high as $2.1 billion (Kovner et al., 2014). socially, or emotionally, such as a reported at least one act of bullying higher social status, or is physical- (Clarke et al., 2012). To promote the con- ly larger or emotionally intimidat- versation within nursing student mem- ing, and bers of the National Student Nurses • repetitive behavior; however, Association (NSNA), the investigators Renee Buonaguro, PhD, RN, ANP-C, has bullying can occur in a single inci- raised the question: What are the experi- been working in nursing for over 20 years in dent if that incident is either very ences of the NSNA student members and major metropolitan hospitals, as well as severe or arises from a pattern of how do they react to these experiences? the pharmaceutical industry, and as an behavior (PACER’s National Adjunct Instructor at Barbara H. Hagan School Background Literature of Nursing at Molloy College for over 10 years. Bullying Pre vention Center, Research studies of school bullying She is a past Jonas Nurse Leader Scholar and 2020, para. 6) began with Olweus during the 1980s and Sigma Theta Tau member. Volume 42, No. 2 • Fall 2020 1 Figure 1. Bullying Incidents Among Nursing Students If you have been bullied, which of the following best describes your reaction(s) to the bullying (check all that apply). 60% 50% 40% 30% 20% 10% 0% I deal with the effects I try to of bullying I talk with I report I talk face I talk to a I consider work in I talk with my family harmful to face I can’t Other psycholo - them a I can’t I talk to my I ignore regularly in unhealthy I try to my friends or a I talk to the behaviors I do with the control (please gist or to joke and control fellow such a planned ways (e.g. I retaliate. tolerate it. and ask for relative faculty. to the nothing. bully about myself and write your my don’t take myself and students. behavior. manner to smoking, their help. and ask for higher the cry. reason). healthcare them scream. avoid drinking help. authorities. problem. provider. seriously. criticism. alcohol, over - eating). Responses 57% 41.2% 39.5% 37.8% 37.1% 34.6% 32.6% 29.8% 26.7% 21.4% 17.3% 17% 15.9% 15.7% 6.6% 2.1% 0.5% Purpose SurveyMonkey® for students at all levels. education and several of the meaningful The purpose of the NSNA bullying The items were developed specifically for phrases from the open-ended questions study was to explore the dynamics of bul- this project and included several demo- state the impact it is having on nursing lying – statistically and qualitatively – as graphic questions with open-ended students today in their own words. reported by students. In response to phrases developed to capture the stu- The sample included 87% (1,139) reports of this growing problem and in dents’ self-reported experiences. With females and 12% (149) males. Their ages order to identify how bullying is described over 1,000 student responses from pri- ranged 18-22 (27%), 23-28 (27%), 29-35 by members of NSNA, the organization marily junior and senior participants (n = (20%), and 36 or over (25%). Type of pro- launched an initiative beginning with this 1,315), the results were examined statisti- gram attended included: Associate survey. The purpose of this study was to cally and coded for the qualitative analy- Degree (34%), Pre-licensure Baccalau - describe the incidence of whether or not sis to highlight in their own words some reate (52%), Diploma (3.7%), Direct Entry students report they are bullied, in what of their bullying experiences and its effect Masters (3%), and RN to BSN (8%). The relationships, and how they describe the on them personally. respondents expected graduation date experiences in their own words. The Bullying is a sensitive subject to ask included: 46% (Year 2020), 31% (Year “Two-Minute Survey” is part of a routine participants to self-disclose and the study 2021-2022), 23% (Year 2023 or other). activity where students of NSNA are sent was IRB approved. SurveyMonkey pro- An overwhelming 71% of nursing (via e-mail) a brief survey with minimal vides protection that all responses are students in the survey were bullied and questions (i.e. under 2 minutes to com- anonymous. Consent was implied in their 29% were not. Of those who were bul- plete). The questions are brief, open- willingness to participate by clicking the lied, 44% were bullied by faculty, 37% by ended, and elicit how participants link. Participants were allowed to stop at fellow students, and 33% by hospital respond to the questions in their own any time; however, they appeared to be staff. Not surprisingly, there were signifi- words: eager to tell their stories as evident in the cant gender differences for males versus amount of lengthy typed-in responses. 1) Have you been bullied? females who answered: “not bullied” 2) If you have been bullied, please (35% males versus 28% females) and for provide a short description of Results “bullied by fellow students” (27% males the situation including who bul- The results yielded a total of 1,315 versus 38% females) (p < 0.05). The lied you. survey responses and 995 qualitative responses to the question about the bul- 3) Please briefly describe how the data entries with lengthy narrative lying incident(s) offer a snapshot into how bullying situation was handled. descriptions that were analyzed using constant comparative content analysis. students reported their reactions (see Methods The quantitative statistics on this large Figure 1). Although most students have a To recruit NSNA members, question- national survey provided several insights minimal type of reaction such as “toler- naires were posted on the website using about the problem of bullying in nursing ate, ignore, do nothing, talk with people I 2 Volume 42, No. 2 • Fall 2020 trust about the incident,” there was a • “I stood up for myself and • “I went home and cried, told large number of reactions that were informed them to stop.” myself I won’t be in nursing school directed inward including “talk with psy- • “I went to the student advocate at forever, got over it and got back to chologist, lose control and cry or scream,” the school and used them as an work.” and unhealthy behaviors that are con- intermediary to solve the issue • “I cried.” cerning. Only 21% stated they talked with with me.” • “I was afraid of retribution. I didn’t the bullies about the problem. • “I finally went to the dean of nurs- know who to go to. I didn’t even There was a large number of re - ing and explained about a faculty feel safe giving her a review sponses to the open-ended question.
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