Some people could reason that the nursing career is more demand for nurses than what it offers. Working for long shifts, addressing trauma, handling various complicated patients while frequently short of nurses, working with no sufficient mealtime breaks and consoling dejected family members is just the tip of the iceberg for hospital-based nurses. Often, nurses appear to perform their job smoothly in spite of how complex their work is. Nurses are compassionate, selfless and graceful, qualities the society expects from them. Unfortunately, even with the stellar reputation which they relish, a buried culture of bullying, hazing, disruptive behavior and abuse exists on hospital units across the United States (Johnston, Phanhtharath, Jackson, 2010). The American Nurses Association (ANA) describes bullying as "repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient," is a profoundly severe problem which threatens nurse sanity and health, patient welfare, and the entire nursing job. Besides, bullying threatens communication, morale and teamwork.
Bullying activities range from exclusion to humiliation and eye-rolling, concealment of information, intimidation, scapegoating and backstabbing. Such actions are intentional. The bully aims at destroying the credibility and confidence of the victim as a way of gaining control and power. According to Townsend (2017), in a study by Hutchinson and associates on Australian nurses and bullying behaviors, the participants described three forms of bullying – the erosion of professional image and competency, personal attack and attack via work responsibilities and roles.
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Bullied nurses are affected on different ways, which include psychological effects like depression, being unable to concentrate on their job, sleep disorders, anxiety, and exhaustion. In a study perfumed by Longo in 2013, aging nurses were found to suffer from complex physical consequences of bullying like headaches, musculoskeletal problems, abdominal conditions, and cardiovascular diseases (Townsend, 2017). Also, elderly nurses experience embarrassment and embarrassment when they are bullied by other staffs. Bullying victims at all ages present higher absenteeism and could show reduced productivity as a result of stress and the interference of attempting to stay out of the way of the bully.
Moreover, patients are not immune to the consequences of bullying. When the environment of work is toxic, there is a halt in teamwork, communication, leadership and collaboration. When nurses are uncomfortable asking for help, they have a higher likelihood of making mistakes — adverse patient outcomes, as well as patient mortality, upsurge in environments where workstation bullying happens. As stated by the American Association of Critical-Care Nurses, toxic work settings result in rise in hospital-acquired disorders along with patient readmission (Wilson, Diedrich, Phelps, Choi, 2011; Townsend, 2017). These adverse patient outcomes, together with poor patient satisfaction levels, as well as lead to poor care quality and reduced financial reimbursement. Higher nurse turnover reduces the continuity of communication and care.
In addition to having adverse effects on the health of workers, provision of quality care, and the safety culture, bullying in nursing as well leads to the shortage of nursing faculty. There is increased nurse discontent in their work, which contributes to the constant struggle, and thus, nurses end up quitting their positions as well as retiring early. Similarly, bullying and incivility have severe outcomes for healthcare organizations (Townsend, 2017). Losses in productivity associated with incivility, which result from reduced work quality, decreased physical ability, impaired time management and absenteeism, are some adverse impacts of bullying on an organization. Furthermore, nurse turnover affects organization's financial turnover. Walrafen et al. (2012) reported that the average budget of replacing a single experienced nurse could amount to $64,000. Also, it is hard to hire nurses to work in a facility which has a bullying culture.
Consequently, there is a need for nursing leaders and managers to understand the cause and impact of bullying and potential approaches to reducing bullying rates. Although there is evidence of bullying in the nursing profession, nursing professionals are ill-equipped to address it. There is little if any formal preparation or education for front line staff and managers. Even though the managers could be the bully, they might as well be bullied or even scared of managing the issue. Also, there could be an absence of organizational support for encouraging a healthy work setting.
However, various strategies could be used in managing bullying. One approach is through communication and development. People who feel that they have a voice in the workplace are most likely to speak up. Open communication forums, unit-based councils, and shared models of governance among various levels could help in handling bullying. These approaches are practical as they empower each person and put value and importance on what staffs observe, feel and share. Promoting a just culture and providing an open-door policy are the most practical measures for supporting empowerment. Through the use of the same principle as the "stopping the line," concept, workers are empowered to put a hard to stop on what they feel is bad behavior. The actual implementation of zero-tolerance policies should complement empowerment and communication. Behavioral codes of conduct and standards should be taken seriously, and issues dealt with as they emerge.
In dealing with the issue of bullying in the nursing profession, nursing leaders and managers could adopt a democratic style of leadership. This is a management style whereby the group members are more participative in the process of decision-making. Each is given a chance to participate; there is a free exchange of ideas, and promotion of discussion. Although the democratic process is likely to emphasize group quality and the free flow of ideas, the leader is still there to offer direction and control (Giltinane, 2013). This style of leadership could be among the most effective leadership styles, as it values collaboration and affirmation of group members.
A democratic leader takes into consideration the input and feedback of the team members before making decisions. Thus, this would help in addressing bullying as it would empower the staffs by making them feel their voice is heard and their contributions matter, thus promoting high employee engagement as well as workstation satisfaction levels. In a democratic leadership the duties of making decisions and resolving problems are shared with the team while the manager makes the final choice. The style fosters team involvement, participation and engagement, and thus employees would feel free to share their issues and concerns such as the bullying behaviors of their workmates, and any viable solutions to such problems when they arise (Giltinane, 2013). Further, a democratic leadership produces workers who are highly motivated to create and offer innovative solutions and also create a sense of team spirit and collaboration, therefore decreasing bullying.
In conclusion, bullying adversely affects the nurses, patients, and the healthcare facility. Hospitals experience higher rates of turnover which are very costly. Low quality of patient care, ] as well as discontent, lead to decreased financial compensations, which also undesirably impacts the facility’s bottom line. Inability to fulfill patient safety benchmarks could further impact accreditation and financial position. If an unhealthy environment is permitted to continue, it will affect each component of the organization, such as staff and patient satisfaction, care quality, and hiring and retention. Therefore, the nursing leadership should resolve the issue by empowering the employees to speak up about it, and this collaboratively finds a solution. A democratic leadership style, in this case, would be the best as it would make employees feel that their voice is heard and thus they would be willing to share the problem with the management and together work towards a solution.
References
Giltinane, C. L. (2013). Leadership styles and theories. Nursing Standard, 27(41).
Johnston, M., Phanhtharath, P., Jackson, B. S. (2010). The bullying aspect of workplace violence in nursing. JONA'S Healthcare Law, Ethics, and Regulation, 12(2), 36–42.
Townsend, T. (2017, June 9). Not just 'eating our young?: Workplace bullying strikes experienced nurses, too. Retrieved from https://www.americannursetoday.com/just- eating-young-workplace-bullying-strikes-experienced-nurses/
Walrafen, N., Brewer, M. K., Mulvenon, C. (2012). Sadly caught up in the moment: An exploration of horizontal violence. Nursing Economic$, 30(1), 6–12, 49.
Wilson, B. L., Diedrich, A., Phelps, C. L., Choi, M. (2011). Bullies at work: The impact of horizontal hostility in the hospital setting and intent to leave. Journal of Nursing Administration, 41(11), 453–458.
