Bullying By Mary Pat Szutenbach ROOTS,in RATIONALES, Nursing: AND REMEDIES 3.0 contact hours ABSTRACT: Bullying and incivility are sadly, far too common in today’s healthcare work- places. This article reviews early to current literature, identifies types of bullying, offers four root causes, and suggests responses to impact these causes using Gibbs’ Reflective Cycle, biblical Scripture, and an allegory “How to Swim with Sharks.” KEY WORDS: bullying, Gibbs’ Reflective Cycle, incivility, lateral violence, nursing 16 JCN/VolumeJCN / Volume 30, 30,Number Number 1 1 journalofchristiannursing.com Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. “Her statements became increasingly aggressive and she ultimately told me to ‘go slide down a razor blade.’” A SADLY COMMON STORY in the baby’s right hand, taped on a started shouting at me. I convinced ess than a year after graduation padded board with the board pinned her to move our interaction into the from nursing school I was com- to the mattress. I checked the IV and medication room, where we could talk Lmissioned in the military and it was patent and showed no signs of in private. Brenda continued to yell at assigned to a combined adult and pe- malfunctioning, so I reset the pump me and told me never to touch her diatric unit in a small hospital. While in and returned to the nurses’ station. patients. Her statements became increas- orientation I was asked to provide one- A little later it alarmed again. When ingly aggressive and she ultimately told to-one care for a critically ill child who I went in the second time, I noticed me to “go slide down a razor blade.” could not be placed in in- I left the interaction tensive care. I was lauded feeling stunned wanting for how I handled the to understand what I child’s care and from that had done to precipitate point forward Brenda,* a Brenda’s attack. I cer- nurse several years senior tainly wanted to avoid to me, seemed guarded frustrating her again. around me. She began to My subsequent shifts withhold information and with her were difficult; gave me assignments that Brenda appeared to look at times seemed unfair. for opportunities to find One particular shift, fault in my actions and Brenda was responsible I felt she was withhold- for the pediatric patients ing greater amounts of in our unit, and I cared information than before for the adults. While the incident. There was a Brenda was busy with continued air of hostility a patient, the intrave- between us that dimin- nous (IV) pump started ished slightly over time to alarm in one of her but never went away. assigned rooms. I went Similar situations have into the baby’s room been occurring between and began to trouble- nurses for years and are shoot. I found the IV referred to as horizontal hostility, violence, or bul- Mary Pat Szutenbach, PhD, RN, CNS, the baby was trying to suck his right lying. Because nurses’ behaviors have is Associate Professor, Loretto Heights thumb, putting tension on the tape, followed these patterns for decades, it is School of Nursing, Regis University, Denver, Colorado. She served as a which closed off his IV. The baby had necessary for us to ask why, take a hard Lieutenant Colonel in the United no pacifier, so I went to find Brenda look at our history, and attempt to find States Air Force Nurse Corps. who briskly told me she could not be root causes for these problems. *Names have been changed to protect privacy. interrupted. I checked the baby’s chart Accepted by peer review 7/27/2012. and intake status and made him a clear EATING OUR YOUNG? Supplemental digital content is available for liquid bottle of half strength apple The first literature on bullying this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions juice, which stopped him from putting among nurses surfaced in the late 1970s of this article on the journal’s Web site. tension on his IV. and early 1980s. Kohnke (1981) and The author declares no conflict of interest. When I reported to Brenda what Duldt (1981) spoke of the vulnerability DOI:10.1097/CNJ.0b013e318276be28 had happened, she became angry and of nurses in low-level positions and how journalofchristiannursing.com JCN/January-March 2013 17 Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. Bullying often presents as repetitive acts of verbal aggression and criticism but may take more subtle forms, such as placing someone under increased scrutiny or talking behind another’s back. those nurses were often recipients of In 2000, Freshwater compared 2008) defines lateral violence as “overt verbal abuse. Kohnke suggested nurses nurses’ responses to stress and conflict and covert acts of verbal and nonverbal felt unable to defend themselves because to animal behavior, where stress causes aggression” (para. 1) between nurses in they feared doing so would place them animals to turn on their own young all types of work centers and at all levels in jeopardy of losing their jobs. She and eat them. There is substantial of an organization. concluded that patterns of bullying were evidence in the literature describing Episodes of lateral violence may circular and have been passed from gen- circumstances where nursing students occur as single incidents, but bul- eration to generation within nursing. and new graduates in particular are lying is a pattern of behavior that In 1987, Cox introduced other cannibalized, ostracized, and belittled continues over time. Selekman and reasons for nurse bullying, saying low by experienced staff nurses. The phrase, Vessey (2004) defined bullying among self-esteem or the loss of self-esteem as “nurses eat their young” has been school children (which fits well with a result of repeated criticism contrib- bantered about within and outside of behaviors seen between nurses) as uted to the problem. She added that nursing and caused consternation for “dynamic and repetitive patterns of nurses take on feelings of guilt related to years. Eating our young is perplexing verbal and/or non-verbal behaviors” expressions of anger toward them and because nursing is known as the “car- aimed at another person with the those guilt feelings keep nurses from ing” profession (Unruh, 2005; Zucker intent “to deliberately inflict physical, defending themselves when verbally et al., 2006). verbal or emotional” harm (p. 246). attacked. Randle’s (2003) research with Most nurses excel in caring—at the CAN (2008) quoted the Task Force nursing students reinforced Cox’s asser- bedside to their patients. Yet relation- on the Prevention of Workplace Bul- tions and provided evidence to show ships between nurses often become lying, defining bullying as “an offen- that students’ self-esteem diminished strained and uncaring. It is difficult to sive abusive, intimidating, malicious during their nursing programs. understand how, in one moment, with or insulting behaviour, or abuse of Bullying often presents as repetitive a patient the nurse is the epitome of power conducted by an individual or acts of verbal aggression and criticism caring and, a few moments later that group against others, which makes but may take more subtle forms, such same nurse may attack a colleague. the recipient feel upset, threatened, as placing someone under increased humiliated or vulnerable” (p. 1). CAN scrutiny or talking behind another’s BULLYING DEFINED further clarified that bullying is pat- back. Shortly after starting a new job In addition to bullying, these nega- terned, repeated, and ongoing. Sadly, Noreen,* a seasoned nurse, observed tive behaviors are referred to as aggres- these repeated behaviors break the one of her fellow nurses following sion, horizontal aggression, horizontal victim’s will to defend him or herself behind her after she administered violence, lateral violence, lateral hostil- (Stevenson, Randle, & Grayling, 2006). mediations. Noreen later realized the ity, and incivility. In the last 10 years, Specific acts of bullying and lat- other nurse was checking to make sure vertical hostility has been added to this eral violence take multiple forms and she gave all the medications correctly. list, and specifically describes bully- can be belittling, ignoring, yelling, At the end of one shift Noreen over- ing that occurs between people with a intimidation, back stabbing, eye roll- heard the nurse reporting derogatory “real or perceived power differential” ing, sarcasm, sabotage, withholding of things about Noreen to their supervi- (Selekman & Vessey, 2004, p. 246). information, unequal care assignments, sor. Noreen cried all the way home. Griffin (2004) reasoned the lack of nonverbal innuendo, disrespect for per- She found it difficult to return to universal terminology is partially the sonal privacy, and threats (CAN, 2008). work. When Noreen mustered the basis for why literature on this subject Kupperschmidt (2008) termed the courage to communicate with her has been so diverse. There are equally wounds caused by these hurtful actions manager, the manager merely replied, broad definitions for the terms as there “soul scars” (p. 12). Such scars can lead “Haven’t you heard the statement ‘nurses are numbers of labels for these behaviors. nurses to feel isolated, unworthy, and eat their young?’ That’s just the way it is.” The Center for American Nurses (CAN, undervalued. 18 JCN/Volume 30, Number 1 journalofchristiannursing.com Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited. OSTRACIZED NURSES Nurses Noreen, Julie, and Lydia were of illness and sleep disturbances among The American Nurses Associa- not valued; each suffered from a viola- nurses who were bullied. tion (ANA, 2012) cited Hutchinson, tion of her dignity by those who should Vickers, Wilkes, and Jackson who broke have been mentors and role models.