How to Stop Bullying in Nursing

By LeAnn Thieman. This was originally published on LeAnn's blog.

In the timeless Disney movie, Bambi, Thumper gives great advice. “If you can’t say something nice, don’t say anything at all.” Wouldn’t the world and our work environments be better places if we all heeded the wisdom of that wise little rabbit?

I tried to ignore the problem of lateral violence in the healthcare workplace because I was embarrassed and a bit ashamed that this behavior could be present in our benevolent caring profession. We’ve consistently ranked No. 1 in Gallup’s annual poll of Honesty and Ethical Standards in Professions for the past 15 years. How can we, then, be perpetrators of lateral violence?

I was shocked and mortified to learn that 45% of nurses have been verbally harassed or bullied by other nurses, according to a 2017 survey by employment agency RNnetwork. Forty-one percent said they have been bullied by managers or administrators. Thirty-eight percent reported being verbally harassed by physicians. More than half of the nurses who reported work harassment indicated they were considering leaving the profession all together.

Bullying and disruptive behaviors capture the attention of patients, providers, and visitors, which can extend to the community. Worse yet, it can impact patient outcomes. According to an article published in FierceHealthcare, a 2013 study in the UK reported that one in four doctors and surgeons and one in three nurses said bullying has caused them to behave in ways that are bad for patient care. Seventy-one percent of doctors and nurses linked incivility to medical errors, and 27% tied it to a patient’s death!

So, what exactly is going on? And how do we stop it?

The Workplace Bullying Institute says bullying is repeated, harmful mistreatment by one or more perpetrators who target their victims with conduct that is threatening, humiliating, abusive, isolating, and/or sabotaging. While some forms of bullying are overt, others are more subtle, such as:

• Teasing or saying something mean and then pretending it’s “joking”
• Turning one or more persons against one another
• Shifting loyalties; being friends one day and enemies the next
• Betraying confidences
• Intentionally excluding someone from an event or conversation
• Manipulating someone to do things in a misleading way
• Rolling eyes, sighing, fake smiles, mean gestures
• Using nonverbal intimidation tactics such as glaring or the silent treatment

Sounds a bit like our junior high days, doesn’t it?

Unfortunately, bullying can also be more overt. For example:

• Falsely accusing someone of making errors
• Criticizing in front of staff or patients
• Refusing to acknowledge quality work
• Starting or spreading malicious rumors or gossip
• Shouting or public humiliation
• Stealing credit for work
• Making unreasonable demands
• Sabotaging a person’s work
• Refusing to help them
• Discounting the person’s feelings or perspectives
• Shaming over lack of knowledge

Although anyone can be a target of bullying, often they are the coworkers who are the most positive, kind, cooperative, well educated, well-liked by upper management, or skilled at their jobs. These people are even more prone to suffer greatly at the hands of bullies, sometimes feeling embarrassed and inadequate, resulting in symptoms that may include:

• Stress-related health issues such as heart problems, anxiety, headaches, stomach issues, loss of appetite, insomnia, depression, panic attacks, and frequent illness.
• Low morale, self-doubt, and low self-esteem, both at work and home
• Trouble regulating emotions, concentrating, or making decisions
• Generally dreading going to work or feeling ill
• Feeling drained of energy
• Feeling helpless, depressed, ashamed, or like there is no way out
• Making errors; compromising productivity to avoid the bully
• Reluctance to share ideas for fear of criticism or humiliation

But there are ways to address bullying and create a better work environment for everyone. When targeted by a bully:

• Keep your cool and face this nonsense with grace and dignity.
• Try ignoring it the first time or two, say nothing, and smile (that annoys the heck out of them!) Sometimes when they see they can’t intimidate you, they stop.
• Try using humor to deflect it.
• Ask them if they are having a bad day or if something is troubling them.
• If you feel your own aggression escalating, stay calm. Don’t fuel the situation. Take a few minutes to breathe and regroup.
• Avoid rehashing it with coworkers. That can cause unit-wide drama and coworkers taking sides.

If these simple strategies are not effective, it’s time to take the next steps:

Call it what it is
Acknowledge that you are being psychologically harassed.

Speak up
Politely and quietly call out the incident when it happens. State the problem and the possible consequences if it doesn’t change.  For example, “If you continue to behave this way toward me or speak to me in this manner, I will have to speak with our manager and make a formal complaint.” If the behavior continues, follow through. I taught my kids the difference between being a Ralph Reporter and a Tommy Tattletale. For the sake of a healthy work environment for all, you have the responsibility to report this conduct. Without action, it’s unlikely the bully will change, and certainly not as quickly as needed.

Document it 
Bullies rarely treat someone badly in front of supervisors. Without obsessing about it, document each incident. Record the date and time of each event and eyewitnesses, if any. If bullying is digital or written, make copies. (Before making a digital recording of the abuse, make sure you reside in a single-consent recording state, meaning it’s legal for you to record verbal exchanges without his or her knowledge.)

Report it
Once you document the bully’s behavior, take it to your immediate supervisor. If your supervisor is the bully, report them to their manager. When making your case, frame the issue on how it impacts care and productivity. Even though your emotional toll is legitimate, it’s best to emphasize how the bullying affects team morale, work performance, and patient care.

Expect possible retaliation
It’s likely the bully will hear about your report. Don’t be surprised if they get back at you in subtle ways, even if they’ve promised your manager they will make amends. Record these incidents too, should they occur.

Practice selfcare
Being the target of bullying is extremely stressful. Make your health a priority. Be vigilant about getting good nutrition, sleep and exercise. Practice the Stress Reduction tips and selfcare strategies in your SelfCare for HealthCare™ program. Remember to use your skills of deep breathing, positive thinking, laughter. Forgiveness will be a crucial tool, as well as connecting with your Higher Power.

If you are not a victim of lateral violence, but you witness it, you can have an impact on improving your work environment.

• Derail gossip by switching subjects or injecting positive comments about coworkers, especially the one being harassed.
• Share “positive gossip,” good things you’re heard, especially about the victim.
• When you hear suspicious statements, ask, “Do you know for sure if that’s true?”
• Before you repeat gossip, ask yourself, “Is it helpful? Would I say it if the person were sitting next to me? What is my motivation for repeating it?”
• If this behavior is affecting your work environment, privately discuss your observations with your manager.

Wise people have known for years that the secret for harmony in the workplace and everyplace is the Golden Rule.  “Do unto others as you would have them do unto you” is the Christian version. But did you know it is the “rule” in most faiths?

“Hurt not others in ways that you yourself would find hurtful.” Buddism
“What is hateful to you, do not do to your fellow man.” Judaism
“No one of you is a believer until he desires for his brother that which he desires for himself.” Islam
“Blessed is he who preferred his brother before himself.”  Baba’i Faith

Though simple, this message is radical and contrary to human nature. Human nature is to treat others the way they treat you. But doing so puts them in control. Theirbehavior determines your behavior. The Golden Rule puts you I control. Let’s control our own behaviors, communication, and workplace environments.

Another strategy before speaking or acting is to apply the Rotary International’s Four-Way Test. Of the things we think, say or do, ask the following four questions:

Is it the truth?
Is it fair to all concerned?
Will it build goodwill and better friendships?
Will it be beneficial to all concerned?

Nurses and all healthcare workers endure difficult working conditions, often going for prolonged periods without food, drink, or even bathroom breaks (in spite of my nagging!) Perhaps worse, they generally cannot step away for a breather when emotions run high or the atmosphere on the unit is tense. They must stay and keep working, to focus on patients who depend on them. But this is no excuse for unkind disrespectful behavior.

We are all responsible for creating positive, healthy, joyful work environments. Nurses must be able to work as a team and to depend on each other.  We are empowered to keep patients safe, provide high quality care, and deliver a positive patient experience. If bullying or incivility is a common occurrence in your workplace, these outcomes will be compromised. And we took pledges to heal our patients, ourselves and each other.

Let’s do unto others as we would have them do unto us. And if we can’t say something nice, let’s not say…or do…anything at all.

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