Bullying behavior is common in the nursing workplace and has a broad range of negative physical and emotional consequences for the individual nurse, as well as detrimental impacts on outcomes related to the wellbeing of patients and employers, according to a presentation at the Oncology Nursing Society (ONS) Bridge, a virtual conference.1

The entrenchment of bullying in the workplace culture can occur in all professions, but is particularly common in nursing, noted Terri Townsend, MA, RN, CCRN-CMC, CMSRN, a staff educator in the department of cardiovascular and outpatient services at the Community Hospital, Anderson, Indiana, and Pamela Anderson, MSN, RN, CCRN, ANP-BC, vascular surgery group, St. Vincent Medical Group, Indianapolis, Indiana, who presented this overview.

Describing bullying as “unwanted and negative behaviors that occur repeatedly and frequently,” and an “intensifying process” that aims to place the targeted person in an inferior position, Ms Townsend noted that bullying could involve gossiping, backstabbing, eye rolling, withholding information, willful humiliation, and even physical acts of aggression, among other behaviors.

The prevalence of this problem in the nursing profession was demonstrated in the results of the 2018 Healthy Work Environment Study, in which 8080 critical care nurse participants completed an online survey on characteristics of their work environments.2


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Key findings of this study included reports of at least 1 episode of bullying and verbal abuse by another nurse by 80% and 34% of these survey participants, respectively.2

Nurses are an example of a group, characterized by “a hierarchy that tends to stifle a group of people under them and keep them subordinate.” Such a situation can lead to group members acting out against each other, and may be facilitated by a hospital environment, noted Ms Townsend. 

Furthermore, bullying may be seen as a “rite of passage” that becomes embedded within the nursing workplace culture, and may be characterized by “generational conflicts” in which older nurses place younger nurses in situations beyond their capabilities to test their tolerance. However, the marginalization of older, more seasoned nurses by younger nurses is also an example of bullying.

Bullying behavior is not limited to peer-peer interactions, and can be inflicted by instructors on their nursing students, as well as by nurse managers who subject their staff to abusive supervision practices, such as favoritism and the protection of bullies on the unit. In addition, nurses can be subjected to bullying by difficult providers. 

In addressing the consequences of bullying in the nursing workplace, Ms Anderson cited a survey study that evaluated the impact of bullying on the health of nurses. The results of this study showed an increased risk of cardiovascular disease and type 2 diabetes, as well as worse psychological health, among nurses who reported experiencing a higher incidence of bullying.3

Beyond its impact on the individual nurse, it was noted that nurse bullying can adversely affect patient outcomes through a breakdown in communication and teamwork that may result in increased medication errors, as well as other negative consequences for the patient.

Moreover, nurse absenteeism and training costs due to staff turnover are potentially increased and can have a negative impact on the health of the organization that employs the nurses.

Addressing workplace bullying first involves recognizing the existence of the problem, and then searching for the root causes. Creation of a collaborative environment in which workers are empowered to report incidents of bullying and to intervene in situations where bullying is occurring, encouragement of multidisciplinary communication, and implementation of educational programs focused on workplace bullying were mentioned as key elements of approaches to combat bullying in the nursing workplace. 

References

1. Townsend T, Anderson P. From the playground to the nurses’ station: understanding and eliminating workplace bullying and incivility. Presented at: Oncology Nursing Society (ONS) Bridge; September 8-17, 2020.

2. Ulrich B, Barden C, Cassidy L, Varn-Davis N. Critical care nurse work environments 2018: findings and implications­­­­­­. Crit Care Nurse. 2019;39(2):67-84. doi:10.4037/ccn2019605

3. Sauer PA, McCoy TP. Nurse bullying: impact on nurses’ health. West J Nurs Res. [published December 5, 2016]. doi:10.1177/0193945916681278