Recently, I have been part of an advisory panel with the American Nurses Association on workplace violence, incivility, and bullying in healthcare. Actually, I have been studying why these behaviors continue in the “caring” community. I like to laugh at myself, and with that, comes the unique sense of humor of a nurse. I asked the wrong question when I first started. I asked “why do we bully?” I should have asked, “How can we stop it?”
I have learn that all of us can be “the bully” in an environment fueled by stressful events, lack of control over the care to be given, the time to give the “care” to our patients we have been taught is right, and the continued imbalance of power associated with gendered roles outside and inside of work. For those HR people who say coach the bully, coaching also includes progressive discipline. Nurse managers/leaders need to be educated and coached to be able to use progressive discipline not to fire the bully nurse but to rehab him or her back into the group. Parity occurs when the process for disruptive behaviors (bullying) is equally applied to physicians and nurses, which includes Employee Assistance Program intervention.
However, I would like to illuminate the fact that nurse peers and leaders continue the “nurses eat their young” by minimizing or rationalizing the behaviors of others, even their own behaviors. During transition from novice to competent nurse, nurse peers and leaders bully each step of the way creating the next generation of nurses who believe that bullying is normalized behavior. Humans use aggression within families, some more than others. The violence, incivility, and aggression is global, societal, and the healthcare culture reflects normalization of aggression towards its employees. Nearly 35% of those men and women we work with have been affected by bullying or intimate partner violence prior to their license. We all appear to have a willful blindness or personal bias of wanting to be seen in the best light. God forbid we show any weakness least it become amplified by rumors or personal dislike. Authenticity, trust, and work relations are lost behind the façade that must be maintained.
Our profession is fragmented between the various specialties as human care become more complex. The one value linking all professional nursing specialties is nurses “care for” patients. This “caring” makes professional nursing the most trusted profession in the United States. As we work to dissolve the internal work conflict, incivility, and bullying between each other, each nurse is going to have to push the changes necessary to stop the behaviors from continuing to the next generation of new novice nurses by creating a systematic onboarding process for new nurses nationally, advocate to control our own work, advocate for a physical and psychologically safe work environment, and co-create a better work-life balance between employees and employers. it is not the individual nurse that must change. The entire system has to change.
Healthcare organization also need to work with professional nurses for this change to happen for safe patient and cost-effective care, not profit. Profit will increase when quality of care is predicated on safe staffing levels and a “just culture” when there are no gender discrepancies in pay. Nurses are capable of creating and sustaining great change. It is time to create a great change in our response to violence inside and outside the profession.