“Topic: One of the most important issues in the profession of nursing today. 

This paper is a description of one of the most important issues in the profession of nursing today.  There is no “most important.”  You need to identify one issue, present it clearly, using the best evidence you can find, and state why it is important.  In choosing your issue you should use the course descriptions and the objectives of the course.  Your textbook is another good source of ideas for topics, including some of the discussion points throughout the chapters.  The topic can include discussion board topics, and classroom discussion topics.  The issue should NOT be a purely clinical issue, although it can definitely relate to clinical practice.   You should NOT use the debate topic that your are debating (you can use one of the other debate topics).  Your issue should have an evidence base that includes research studies.”

No Place for Bullying

Professional Nursing Practice Term Paper

5 April 2018

Meredith Zwicke

NUR 4130-OL65

Some nurses eat their young. When did this phrase come to be part of the vernacular of our profession, and when did the concept seem to be accepted as a normal component of the job? In what other profession would bullying of colleagues be expected and tolerated? Does this problem stem from a negative stereotype of a female-dominated specialty? Does age play a factor in whether someone is more likely to bully or be bullied? What negative outcomes can occur due to a culture of bullying? What can be done to combat these acts of aggression? This paper will seek to discuss how and why bullying occurs, possible outcomes of bullying for both nurses and patients, and how we can cultivate a culture of professional respect and teamwork.

Bullying is repetitive, targeted behavior that causes the victim to suffer humiliation, threats, intimidation, or abuse and negatively impacts the victim’s job performance, mental and/or physical health, and safety. Bullying is often thought of as occurring between two peers, known as horizontally; however, it can also occur between supervisors and subordinates. This demoralizing behavior can have a profound impact on the emotional health of the victim, often manifesting as physical symptoms such as headache, nausea, and fatigue. Additionally, there is an increased risk for breaches in patient safety such as medication errors, rushed assessments, or memory lapse. “A sizeable percentage of nurses (13%–51%) across different studies have reported that the occurrence of negative behaviours has caused them to make caregiving errors (Báez-León, C., Moreno-Jiménez, B., Aguirre-Camacho, A., & Olmos, R., 2016, p.2).” Bullying frequently occurs as a result of the perpetrator feeling the need to be in total control over a situation and over a person. What might it look like? Examples include unconstructive criticism, unfounded undermining, accusations of incompetence, screaming or yelling in front of others, denial of assistance when requested, lack of action against complaints, or even a dearth of interaction. (Murray, 2009) Bullying can also occur from the management level when concerns are raised and action is not taken.

This behavior can also have an impact on co-workers who are exposed to but not targeted by the conduct, by means of creating a hostile work environment and instilling fear that the attentions may turn to another. In a survey distributed to three hundred and thirty-seven nurses who had self-reported bearing witness to bullying, the number one obstacle to intervention was a fear of retaliation. (Báez-León, C., Moreno-Jiménez, B., Aguirre-Camacho, A., & Olmos, R., 2016) Provision 1.5 in the Code of Ethics for Nurses describes the necessity of a respectful working environment, extending the responsibility of preventing harm to include developing and maintaining civil working relationships. Bullying is expressly stated to be morally unacceptable behavior: “Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors (Code of Ethics for Nurses, n.d., p. 4).” Why then would witnesses still fear retaliation resulting from reporting this conduct?

In the study Factors Influencing Intention to Help and Helping Behaviour in Witnesses of Bullying in Nursing Settings, researchers sought to understand the barriers to helping when witnessing bullying behavior in colleagues and to create a model for predicting when witnesses would take action to assist, rather than remain in a holding pattern of intending to help. Researchers identified five potential factors that might galvanize, tipping the scale from intending to help to actual helping behaviors: guilt, tension, group identity, support to peers’ initiative, and absence of fear of retaliation. All factors were statistically significant in increasing the desire to help when witnessing bullying behavior; however, only the absence of fear of retaliation proved to be a driving force toward taking action to help. This boils down to the cost-benefit ratio that ultimately drives all decision making: how does the cost to self impact the ultimate benefit, and is the net gain adequate in the end? If there is no fear of retribution, any potential harm that could come from standing up for those who are being bullied is negligible.  

With an understanding of the dangers of bullying to self, to colleagues, and to patients; the creation of a provision within the Code of Ethics for Nurses to assert the immorality of bullying; and the vast number of studies, literature reviews, and advocacy initiatives devoted to the concept of bullying within the nursing profession, naturally the question of what to do arises. In his article Workplace Bullying in Nursing: A Problem That Can’t Be Ignored, John S. Murray posits that workplaces must adopt a policy of zero tolerance for bullying conduct and should provide continuing education on identifying and resolving bullying behaviors, and that legislation should be passed nationally within the United States which would protect from retaliation whistleblowers reporting unethical behaviors.

Nursing schools are also leading the charge in an attempt to eclipse bullying before it even begins through role play simulation. Ulrich, D. L., Gillespie, G. L., Boesch, M. C., Bateman, K. M., & Grubb, P. L. (2017) Special attention has been focused on this issue to empower new nurses to reject the ingrained notion that this is simply an issue to be accepted, a rite of passage. Nursing schools incorporate roleplaying to allow students to not only practice being the victim of bullying, but to also practice being a bully, a fellow nurse witnessing this behavior, and the patient watching this interaction unfold before their eyes. As awkward as it may feel to participate in these exercises, one does have the opportunity to gain key insight as to how each role feels to execute and to experience. This also empowers student nurses to speak up at a time in which changing the culture of bullying is crucial. A culture of hostility will not change if brand-new nurses are indoctrinated from the start to accept bullying as a part of the job.

Bullying amongst colleagues has been a pervasive affliction within the nursing profession for years and it must end now. This phenomenon has been pervasive and degrading, it has been damaging to the point of driving away new nurses and demeaning current nurses, and it has cost the highly-considered field of nursing points of respect amongst local communities. When we have a reputation of eating our young, how could we ever progress to a level of respect, fairness, and honesty within our profession? Could we truly say that our patients are the most important aspect if we demonstrate mistrust, micromanagement, and bullying amongst our colleagues? We must empower each other to acknowledge and report the bullying that we see, we must support those who are receiving this treatment, and also support those who attempt to report the treatment that they have seen. The only way to combat bullying is through action. If we empower each other to come forward through the chain of command and we show support through our notes of what was seen and when, we have established a positive route toward a more competent, sane, healthy, and respectful working community.

References

Báez-León, C., Moreno-Jiménez, B., Aguirre-Camacho, A., & Olmos, R. (2016). Factors influencing intention to help and helping behaviour in witnesses of bullying in nursing settings. Nursing Inquiry, 23(4), 358-367. doi:10.1111/nin.12149

Code of Ethics for Nurses. (n.d.). Retrieved April 10, 2018, from http://www.nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html

Murray, J. S. (2009). Workplace bullying in nursing: A problem that can’t be ignored. Medsurg Nursing, 18(5), 273.Ulrich, D. L., Gillespie, G. L., Boesch, M. C., Bateman, K. M., & Grubb, P. L. (2017). Reflective Responses Following a Role Play Simulation of Nurse Bullying. Nursing education perspectives, 38(4), 203.