Put a Stop to Bullying New Nurses Laura R. Flateau-Lux, BSN, RN, and Tammy Gravel, MSN, RN ullying among nurses has been discussed in Early Exposure to Bullying the nursing literature for nearly two de- In the clinical setting today, nursing students are Bcades.1 The concept has been identified with exposed to bullying behavior early in their nurs- many terms, such as horizontal violence, lateral ing education. Stevenson, Randle, and Grayling violence, and relational aggression.2-4 All of these conducted a survey that measured the fre- can be best described as forms of psychological quency and types of bullying behavior among and social harassment perpetrated by one nurse 313 second-and third-year nursing students in against another through overt and covert behav- the United Kingdom during their last clinical iors.3,4 Examples of covert behaviors include placement. About 53% of nursing students in this nonverbal cues, deliberately withholding infor- study indicated that they’d experienced some mation, gossiping, and sharing private informa- form of bullying during their clinical placement tion that wasn’t intended for others to know. from physicians and senior members of the nurs- Overt behaviors are more blatant and include ing staff within specialty areas such as adult sabotaging another nurse, scapegoating, taking medicine, pediatrics, and mental health. The actions that prevent another nurse from doing most common behaviors indicated were being his or her job (such as hiding items needed for ignored/excluded (34%), experiencing destruc- patient care), forming cliques, and exhibiting tive criticism (30%), resentment (29%), and being passive-aggressive behavior toward a particular humiliated in the presence of others (29%).5 nurse.3 Simons set out to explore bullying experi- This article discusses the effects of bullying on enced by newly licensed RNs in Massachusetts nursing students and new graduate nurses enter- and its effect on intention to leave the workplace. ing the workforce and explores strategies for The target population for this study was nurses changing a culture of bullying on nursing units. who were newly registered and less experienced, This article originally appeared in the Nursing2013 2013;43(6):24–28. vol. 32 • no. 4 • April 2014 Home Healthcare Nurse 225 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. because the researcher discovered from a litera- bullying against newly licensed RNs during their ture review that this population was the most first year of practice in New Zealand. The goals of vulnerable to bullying.6 Out of 511 survey re- the study were to identify the types and preva- spondents, 78% were grouped into the novice lence of bullying behaviors toward nurses within category (defined as nurses who’d had their their first year of practice, explore the impact of license for 36 months or less).7 Thirty-one per- these behaviors psychologically, understand the cent of respondents indicated that they’d been consequences of this behavior, and determine to bullied based on these criteria: On a weekly or what extent these new nurse graduates received daily basis over the last 6 months, the RNs expe- training to manage bullying. rienced at least two negative behaviors perpe- Out of the 1,169 questionnaires mailed, 551 trated by another nurse.6 respondents completed questionnaires for a re- The researcher additionally sought to mea- sponse rate of 47%. Results indicated that: sure the intention to leave the place of employ- ment among those bullied. Simons found that • over 50% reported feeling that they were bullying had more influence on intent to leave being treated like a student than any other factor, including marital status, • 46% reported being given a lot of responsibil- race, and earned income. While the results of this ity without supervision study support the concept of bullying among • 34% reported being denied access to learn- nurses within the clinical setting, the researcher ing opportunities couldn’t conclude that bullying occurs more • 34% felt emotionally neglected often among newly licensed nurses within their • 20% indicated that they were told by another first 3 years of practice compared with experi- nurse that they’d endure repercussions for enced nurses who are newly licensed in Massa- speaking out against bullying behavior.2 chusetts by reciprocity from the sample provided by the Massachusetts Board of Registration in Several respondents reported psychological Nursing.6 consequences that included frustration, fear, de- At the end of this survey was an open-ended pression, anxiety, and mistrust. A few reported section for participants to provide any com- physical consequences, such as headaches, ments on the concept of bullying. Out of the weight loss, and fatigue. original 511 respondents, 184 nurses completed Forty-one percent of respondents indicated the comment section. In 2010, Simons expanded that they’d had some form of undergraduate on the original study using a qualitative design to training to help identify and manage interper- share the respondents’ experiences, as this fur- sonal conflict among staff. Only 13% indicated ther demonstrated the concept of bullying in the that they’d had some form of training to manage workplace. Four themes were identified in the interpersonal conflict since becoming an RN.2 stories provided by the respondents: structural bullying (perceived punitive and undue actions Repercussions During the First Year taken by supervisors), nurses eating their young, of Practice feeling out of the clique, and leaving the job. A review of the literature establishes that nurses Some of the most notable comments on these in the clinical setting experience bullying, both in four themes involved being given a workload that the United States and abroad. International stud- wasn’t manageable, feeling like senior nurses ies have further supported the concept that bul- took joy in keeping information to themselves at lying is most prevalent against new nurse gradu- the expense of the new nurse, feeling alienated, ates during their first year of practice. When a and intentions of leaving their job and/or the new graduate enters the workforce, his or her profession as a result.8 first real position creates an impression of the nurse’s role in healthcare.9 Bullying in the First Year of Practice A nurse’s first year of practice is a time for Most of the research on bullying among nurses acquiring new skills and knowledge and building with up to 1 year of experience has been con- confidence. New nurses are typically enthusias- ducted in the United Kingdom and New Zealand. tic about caring for patients and want to make a McKenna et al.2 conducted a classic study exploring difference in the world. They enter the profession 226 Home Healthcare Nurse www.homehealthcarenurseonline.com Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. with the assumption that they’re needed, yet some are greeted with behaviors from seasoned International studies nurses that can be psychologically distressing. have further supported The resulting interpersonal conflict, job conflict, the concept that bullying and stress leave the new nurse with a less posi- tive impression about the role of a nurse. This is most prevalent against issue can create such a distraction that it com- new nurse graduates promises patient care.10 Research suggests that during their fi rst year of bullying behavior must be exposed in order to stop it and to implement programs that allow practice. new nurse graduates to grow and develop confi- dence within their profession.2 with colleagues and others with a commitment to Nurse Retention and Patient the fair treatment of individuals, to integrity- Safety Issues preserving compromise, and to resolving conflict.”13 As the bullying phenomenon continues and im- Can this be said for the culture of nursing pedes the professional growth and development today? Fostering a culture that condemns bully- of newly licensed nurses, it may directly impact ing against nurses is an obligation for nursing staff retention. According to Griffin, after 6 leaders. months of employment, 60% of new RNs in the In January 2009, The Joint Commission issued United States quit their job due to some form of a set of leadership standards for all accredited bullying.3 organizations that require healthcare institutions Besides undermining the morale of new nurse to: graduates, bullying also compromises patient safety. Nurses who are bullied are less likely to • establish a code of conduct that addresses seek help and ask questions, potentially leading adverse behaviors in the workplace to errors and substandard patient care.11,12 • promote a nonpunitive forum that allows the To ensure patient safety and embrace an envi- reporting of such behavior ronment conducive to learning and patient cen- • create a disciplinary process for those who tered outcomes, any bullying must be addressed bully.14 and eradicated by establishing and enforcing zero-tolerance policies. Addressing and eliminat- Literature suggests that nursing leaders ing this culture of horizontal violence will raise should evaluate unit culture and become aware the profession of nursing by enhancing produc- of the signs of bullying in order to take swift ac- tivity and enthusiasm, reducing risks to patient tion in enforcing the cultural expectations that safety, supporting recruitment and retention, and support a code