Bullying in Healthcare Organizations: Impact on Nursing Practice

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Table of Contents

Introduction
Issue Description and Its Impact
Professional Guidelines and Differing Roles of Nursing Leaders
Additional Aspects to Consider
Leadership Style to Address the Issue
Conclusion
References

Introduction

Bullying is studied in many disciplines, including conflict management, sociology, psychology, jurisprudence, and management. In the science of human resources management, bullying is defined as the deliberate, repeated behavior of one or more subjects (bully) toward one or more employees in order to harm their authority, position in the organization, career, force them to leave their position or fire them from the organization, manifested for six months or more (Thompson, 2019). Typically, workplace bullying does not involve actual physical abuse – although threats of violence are used to intimidate and emotionally distress the victim, they are primarily used as a means of psychological and emotional pressure. Psychologists state that due to the global economic crisis, competition in the labor market has increased, so the methods of workplace terror have become tougher. This paper discusses the problem of bullying in the healthcare sector, assesses its gravity, and offers measures to tackle it.

Issue Description and Its Impact

Bullying takes a variety of forms, ranging from physical, such as kicks, punches, and inappropriate touches, to psychological – intimidation, insulting, and social exclusion. As a rule, the phenomenon develops only in the enabling environment. Typically, the development of bullying is associated with poor management, inexperience in resolving intra-organizational conflicts, and poor processes organization (Maggie, 2017). In this case, the victims are usually prominent individuals who have demonstrated intelligence, competence, a high level of education, and creativity in work. Another option is a situation where management purposefully uses bullying to eliminate unwanted employees (Maggie, 2017). If there was a major conflict among the personnel of a medical institution in the past, or if it is developing at the moment, this is the first sign that the organization has created conditions for bullying or mobbing.

Bullying in business entities is a common phenomenon, but the extent of its influence on the “production process” in healthcare and medicine institutions is only beginning to be recognized. Wright and Khatri (2015) discovered that person-related bullying was a reliable predictor of adverse psychological and behavioral responses and medical errors. Therefore, a workplace environment that is unsafe to medical staff also puts patients at risk. A less obvious, but no less dangerous consequence is the deterioration of organizational culture, non-compliance with the norms of bioethics, and medical deontology (Lever et al., 2019). In addition, the consequences of bullying are expressed in staff turnover, layoffs, and emotional and professional burnout. As reported by Edmonson and Zelonka (2019), 34% of nurses leave or consider leaving because of bullying. All of these negative phenomena are also associated with serious material costs, which are a burden on the organization.

Professional Guidelines and Differing Roles of Nursing Leaders

Bullying has been recognized by leading national medical institutions and become the focus of specific professional guidelines (American Nursing Association, 2015). “Essential VIII: Professionalism and Professional Values” by the American Association of Colleges of Nursing (AACN) highlights the importance of nurses’ workplace accountability and responsibility for their individual actions. The AACN specifically states that in the healthcare sector, professionalism is impossible without civility. The American Nursing Association’s (ANA) Code of Ethics prescribes nurses treat colleagues, students, and patients with utmost dignity and respect. The ANA condemns all forms of workplace bullying and harassment and proposes zero-tolerance policies. Furthermore, the milestone 2010 Institute of Medicine report calls for collaboration between nurses. These professional guidelines should be manifested and put to practice through the emergence of an organizational culture that honors human dignity and autonomy.

During a workplace conflict, nursing leaders and nursing managers have to take an active role and intervene. A document that describes their differing roles is the position statement developed by the Professional Issues Panel on Incivility, Bullying, and Workplace Violence of the American Nursing Association (ANA) (2015). The document states that nursing leaders need to become familiar with incivility and bullying prevention policies and procedures. If no such policies exist, leaders are obligated to take part in their development. Nursing leaders establish a system of code words and signals as well as incident reporting to facilitate information spread and exchange. At all times, nursing leaders need to uphold standards of professional demeanor and be role models for treating others with dignity and respect. In turn, nursing managers take action on a larger scale: they develop anti-bullying policies, organize training sessions, and orient new employees. They may also establish evidence-based practice committees that could brainstorm solutions to bullying-related problems.

Additional Aspects to Consider

Fighting workplace terror is quite difficult since official measures are not only ineffective but also increase tensions within the collective. A leader who seeks to rid the team of bullying manifestations must, first of all, take a strictly neutral position. Further, it is necessary to define a “trust agent,” like a “change agent” in the case of large-scale corporate changes, with whom it will be possible to communicate about conflicts in the team on the condition of anonymity. He or she will not only help to identify the problem but will also actively participate in drawing up a plan to solve the problem (Roussel et al., 2018). In the process of implementing this plan, training, workshops, courses for managers, and team building sessions may be held. In addition, business companies often stipulate responsibility for bullying in employee contracts. Awareness of responsibility greatly reduces the risk of such conflicts. These practices can be successfully applied in a medical institution.

Leadership Style to Address the Issue

In addition, it is possible to not only fight against the manifestations of bullying in the team but also to prevent its occurrence even at the stage of the inception of the conflict. This requires the use of an effective leadership style and concept. For this reason, the WHO Regional Office for Europe has embarked on plans to establish a Pan-European Academy for Transformational Leadership (Roberie, 2020). Researchers believe that, in general, this style of leadership is more productive than traditionally applied in healthcare transactional leadership (Saleh et al., 2018). Dussault and Frenette (2015) empirically proved that out of all leadership styles, it was transformational leadership that was negatively associated with bullying. Transformational leaders influence the core attitudes and values of people in organizations, creating a shared vision of reality that enables them to successfully achieve organizational goals.

Conclusion

Bullying in clinical settings is a serious issue that not only impacts the mental well-being of all people involved but also compromises patient health outcomes. This phenomenon does not occur randomly but rather manifests itself in enabling environments. For this reason, it is critical to creating an organizational culture that incorporates key national guidelines on workplace violence and incivility. In the case of bullying, nursing leaders take a hands-on approach while nursing managers make decisions on a larger scale by developing policies and starting educational initiatives. Transformational leadership may be the best leadership style for organizational change that eradicates bullying.

References

American Nurses Association. (2015). American Nurses Association Position Statement on incivility, bullying, and workplace violence. Web.

Dussault, M., & Frenette, É. (2015). Supervisors’ transformational leadership and bullying in the workplace. Psychological reports, 117(3), 724-733.

Edmonson, C., & Zelonka, C. (2019). Our Own Worst Enemies: The Nurse Bullying Epidemic.Nursing Administration Quarterly, 43(3), 274–279. Web.

Lever, I., Dyball, D., Greenberg, H., & Stevelink, S. (2019). Health consequences of bullying in the healthcare workplace: A systematic review. Journal of Advanced Nursing, 75(12), 3195-3209.

Maggie, C. (2017). Fast facts on combating nurse bullying, incivility and workplace violence: What nurses need to know in a nutshell. Springer.

Roberie, R. (2020). Establishing the pan-European transformational leadership academy.Psychology Life. Web.

Roussel, L. A., Thomas, T., & Harris, J. (2018). Management and leadership for nurse administrators. Jones & Bartlett Learning.

Saleh, U., O’Connor, T., Al-Subhi, H., Alkattan, R., Al-Harbi, S., Patton, D. (2018). The impact of nurse managers’ leadership styles on ward staff. British Journal of Nursing, 27(4), 197-203.

Thompson, R. (2019). Enough! Eradicate bullying and incivility in healthcare: Strategies for front line leaders. Incredible Messages Press.

Wright, W., & Khatri, N. (2015). Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Management Review, 40(2), 139-147.

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