3 Faces of Bullying in Health Care
Bullying in health care shows up in many forms. Here are some examples.
Bullying by a patient
An angry young male is admitted to the hospital after he was shot by police during a drug deal. He becomes demanding and treats the nurses like they are his personal servants. One of the nurses finds a tape recorder in his bedside table and spreads the news to the other staff. The nurses are suspicious about why he is taping conversations and fear he will take words out of context and sue them. Pretty soon no one wants to take care of him.
Bullying is an offensive, intimidating, malicious or insulting behavior or abuse of power conducted by an individual or group against others, which makes the recipient feel upset, threatened, humiliated, or vulnerable. This undermines self-confidence. Bullying is behavior that is generally persistent, systematic, and ongoing.
Bullying by a physician
An operating room nurse is assigned to work with an orthopaedic surgeon. Before surgery begins, the male nurse tells the male surgeon that he is not often assigned to orthopaedic cases. After surgery, the male surgeon grabs the front of the nurse’s scrub top with his bloody glove and berates him for his performance. When the nurse asks him to remove his hand, the surgeon sneered, “Are you afraid I am going to hit you?”
Bullying is a disruptive form of communication a person perceives to be harsh condemnatory attack upon herself or himself professionally or personally. It includes demeaning comments, intimidating or condescending language or intonation, and issuing threats.
Bullying by colleagues
A nurse is hired as a nursing administrator. Her peer group members are the nursing supervisors. When she sits down to eat lunch with them, she is greeted by silence. She tries to start conversations, which sink like a stone without responses. After she attends an out of state Joint Commission conference, the silence gets worse. This new employee previously got along well with others, but is puzzled by the reception she receives from the nursing supervisors.
Bullying includes silence and social ostracism.
All of these are real instances of bullying in health care. What was the rest of the story?
Bullying by a patient
The nurses, with their nursing supervisor, worked out a plan of care to set limits on the angry young man’s behavior. They rotated him to a different nursing unit every month until he could be discharged. He lost his power to intimidate people and modified his behavior.
Nurses are educated to develop plans of care to deal with manipulative patients who test the limits and display bullying in health care environments. The bullying of this patient kept him in control until the nurses took back their power and developed a unified approach to deal with his behavior.
Bullying by a physician
The operating room nurse reported the surgeon’s behavior to the nursing administration. They explained that the surgeon brought a lot of patients into the hospital and that they could not change him. The nurse found this frustrating.
The nurse knew two relatives of his were planning to have orthopaedic surgery within the next month. He convinced his relatives to change surgeons and have a different surgeon at a different hospital perform the operations. The nurse’s employer and the surgeon both experienced financial repercussions of the changed surgical plans.
The Joint Commission standards require facilities to have policies on how to deal with disruptive behavior. Some facilities have a zero tolerance policy, which means they will tolerate no incidents of disruptive, bullying behavior. In these settings, this orthopaedic surgeon may have been removed from the staff.
Bullying by colleagues
The nursing quality assurance coordinator stopped trying to eat lunch with her colleagues and teamed up with another nursing administrator who was friendly to her. She learned the supervisors were jealous because she was sent on an out of town trip. She never felt there was a good fit between her and the hospital. At the end of a year working at the hospital, the nurse resigned her position and started her own LNC business. This is my story.
Social ostracism and silence are subtler forms of bullying than the abusive, disruptive behavior of the patient or orthopaedic surgeon. Yet they have power to wound and prevent the development of a well-functioning team.
Have you encountered bullying in your career? How did it affect you? How did it get resolved?
Pat Iyer MSN RN LNCC is the founder of Med League Support Services, Inc. She shared these stories and more during a presentation on bullying at the International Council of Nurses in Melbourne, Australia, in May 2013.