Nursing Practice Keywords: Whistleblowing/Behaviour/ Wellbeing Discussion ● This article has been double-blind Workplace bullying peer reviewed Bullying can have extensive effects on nurses at work but action can be taken to dealing with this destructive behaviour Bullying in nursing and ways of dealing with it In this article... 5 key Research into workplace bullying points Types of bullying Bullying in the How to prevent and combat bullying in the workplace 1workplace is a worldwide phenomenon Author Ludwig F Lowenstein is director, individual and organisational factors It is not only Southern England Psychological Services, (Johnson, 2009). Johnston et al (2010) 2senior staff Allington Manor, Hampshire pointed out that the issue of workplace who bully; often Abstract Lowenstein LF (2013) Bullying in violence and bullying is something of nurses bully each nursing and ways of dealing with it. which all organisations must be aware as it other Nursing Times; 109: 11, 22-25. affects staff and, in the case of nurses, it Bullying can As with many other professions, nursing can also affect patients. 3often affect has its share of bullies who discredit the Negative workplace behaviour such as nurses’ ability to profession, while other nurses work with bullying is a worldwide problem (Lindy provide high- dedicated efficiency and good will. and Schaefer, 2010). A Portuguese study by quality care Bullying has an impact on the workplace Sa and Fleming (2008) described nurses Organisational environment and nurses in general; it can being bullied in the workplace: “[The] indi- 4characteristics cause low morale and in some cases can vidual is persistently treated in an abusive are critical make nurses seek employment elsewhere manner over a period of time, with a antecedents of or even leave the profession. feeling of not being able to counter-attack bullying This article considers recent research or defend him/herself against the abuse.” Policies to deal into bullying in the workplace, including its Workplace bullying has attracted 5with the prevalence within the profession, causes increased attention over the last 10-20 possibility of and identification, as well as different years due to greater awareness of the con- bullying in the types of bullying and its impact on victims. sequences for the victims, in this case workplace and It also highlights research into combating, nurses, as well as those they seek to help – “zero tolerance” of preventing and dealing with the problem. the patients. The issue was highlighted this behaviour are recently by the report into the Mid Staf- needed orkplace bullying is a sig- fordshire public inquiry (Francis, 2013). nificant issue confronting the nursing profession, Prevalence of bullying in nursing Wwith victims described as There have been relatively few studies that being part of an oppressed group. There consider the incidence of workplace bul- have been cases where managers have bul- lying in the nursing profession. lied staff or failed to provide support for A study of clinical nurses in Taiwan by possible victims (Jackson et al, 2002). Pai and Lee (2011) reported a high number However, it is not just senior staff who of incidents involving workplace bullying. carry out the bullying; often nurses have Nurses were invited to complete a work- reported that both the bullies and victims place violence questionnaire, which was are the nurses themselves (Hutchinson et designed to assess the frequency and types al, 2006a). of workplace violence or bullying, Needless to say, workplace bullying including physical or verbal abuse, bul- occurs in numerous other occupations and lying or mobbing and sexual harassment. is a complex phenomenon that can only be A total of 521 nurses completed the ques- understood through looking at social, tionnaire; 102 (19.6%) had been subject to Staff may feel unable to defend themselves 22 Nursing Times 19.03.13 / Vol 109 No 11 / www.nursingtimes.net physical violence, 268 (51.4%) had experi- organisational conditions and unsympa- Types of bullying enced verbal abuse, 155 (29.8%) had been thetic leadership styles (Strandmark and Racism and bullying of immigrant nurses, victims of bullying/mobbing and 67 Hallberg, 2007). as documented by Allan et al (2009), sug- (12.9%) reported having experienced Others have noted one of the causes of gests racism is entrenched in the nurses’ sexual harassment. It was noted that bullying to be discrimination towards workplace due to an abuse of power. This working night shifts appeared to increase overseas-trained nurses recruited to work can result in psychological distress and be the likelihood of sexual harassment. in the UK, suggesting that racism can costly to the organisation due to low An American study by Vessey et al sometimes become entrenched in the morale of the nurses being bullied (Cleary (2009) of nurses found that bullying was nursing workplace (Allan et al, 2009). et al, 2010). reported by a wide range of staff. Bullying Hogh et al (2011) found that non-western Gunnarsdottir et al (2006) carried out a occurred most frequently in medical sur- immigrant health workers had a signifi- comparative study of the bullying of gical care (23%), critical care (18%), emer- cantly higher risk of being bullied at work, female nurses, primary school teachers gency areas (12%), operating room/post particularly during their first year of and flight attendants. Repeated sexual har- anaesthesia care unit (9%) and obstetric employment and during their assment at work was more common care (7%). Perpetrators included senior trainee period. among flight attendants, with 31% of nurses (24%), charge nurses (17%), nurse The reasons behind bullying can also respondents from this group reporting managers (14%) and physicians (8%). be political, where it serves the self- they had experienced sexual harassment at Sa and Fleming (2008) found that one in interest of the perpetrators and is fre- work, compared with 4% of nurse respond- six nurses (13%) reported being bullied in quently due to a need for power and com- ents. the past six months. petition for promotion (Katrinli et al, Hutchinson et al (2006b) noted that 2010). A Canadian study by Laschinger et those who perpetrate bullying behaviour Identifying the signs of bullying al (2010) found bullying of new graduate were often found in informal organisa- behaviour nurses by more experienced older nurses tional alliances, which gave them opportu- Victims of bullying tend to feel intimi- to be common. nity to assert some control over teams and dated and often experience job dissatisfac- A recent study by Huntington et al to enforce rules through ritual indoctrina- tion as well as physiological and psycho- (2011) linked bullying to increasing pres- tion, often destroying the self-confidence logical effects (Cleary et al, 2010). sures of work and organisational factors of those targeted and forcing them either Workplace bullying often takes the form of including a lack of support from manage- to comply to survive or to resign their posi- “incivility and humiliations”, which can ment. It also found that workplace bul- tion. This form of bullying can also take lead to shame responses from victims (Fel- lying can be embedded within informal the form of nurses being asked to do tasks blinger, 2008). organisational networks. below their level of competence and An Australian study by Hutchinson et Hutchinson (2009) highlighted that having areas of responsibility removed or al (2006a) found “predatory alliances” ena- bullying is not always identified for what it replaced with more trivial or unpleasant bled bullying in the work setting to be is because it is associated with a whole tasks, something which frequently hap- hidden. In a later study, they found that organisation. Organisational characteris- pens alongside unmanageable workload those carrying out the bullying tactics tics influence both the likelihood of bul- levels (Sa and Fleming, 2008). were often rewarded by being promoted lying occurring as well as whether this Bullying can often take the form of (Hutchinson et al, 2009). Lewis (2006) also behaviour is challenged (Hutchinson et al, cyber-bullying rather than face-to-face. highlighted that managers could be tar- 2010a). Nurses frequently find it difficult This behaviour should be detected, treated gets of bullying themselves by the people to complain about the effects of bullying. and steps taken to prevent it happening above them. Whistleblowing can sometimes be viewed within organisations (Smoyak, 2011). A Chinese research project studied bul- as a revenge procedure (Jackson et al, lying through the use of questionnaires 2010), so organisations can be unaware The impact of bullying such as the Chinese Masloch Burnout that the bullying is even happening (John- Bullying has both a physiological and psy- Inventory, the Negative Acts Question- ston et al, 2010). chological effect on victims as well as a naire and the Overall Job Satisfaction and General Health Questionnaire (Li and Zhang, 2010). These inventories were also FRANCIS ON… used to ascertain whether the question- BULLYING naire accurately measured the bullying that occurred in the nursing population in ● In a Joint Negotiation and Consultation and bullying manner towards her staff a US study (Simons et al, 2011). The study Committee meeting on 12 February and junior doctors, for instance in assessed the concurrent validity of the 2009, reference was made to 30% of making derogatory comments; Negative Acts Questionnaire – Revised (22 staff [at Mid-Staffordshire trust] having ● Dr Turner – a specialist registrar on the items) and findings supported the use of a experienced or witnessed bullying by a A&E department – reported witnessing one-dimensional, four-item questionnaire member of management. a culture of bullying and harassment of to measure perceived bullying in nursing ● After reporting her concerns about staff, particularly the nursing staff, to the populations. senior A&E staff, staff nurse Helene extent of witnessing nurses emerging Donnelly reported she was threatened by from bed management meetings in Causes and victims of bullying colleagues of the nurses she had raised tears in fear of losing their jobs.