The American Nurses Association urges health care to eliminate all forms of bullying and incivility from our workplaces. Nursing and health care leaders, including the ANA, often leap immediately to declare that facilities follow a “zero tolerance” policy when dealing with bullying thinking that it will eliminate the behavior. The literature, however, reveals that this implementation rarely succeeds when used in isolation. One reason is that those enforcing the zero tolerance policies are bully’s themselves. In other words…zero tolerance may have zero effectiveness.

When nurse leaders are silent in the face of bullying and uncivil behavior, they unknowingly (or knowingly) condone the behavior. If staff observes leadership tolerating bullying and uncivil behavior, then they feel they have no recourse and no one to turn to for help; staff does not feel that they can safely report being bullied. The bully sees this silence as acceptance and continues the behavior. Those that bully have a supportive atmosphere to continue terrorizing their colleagues. They are supported as they move ahead in their career and to various job postings within the facility, thus reinforcing the fact that a bully is very often in a leadership position. This is compounded if the bully-leader is also productive and meets the goals of the facility. Very often leaders may not approve of the behavior or even be aware that it is occurring, but the staff understands that silence is acceptance.

It is a well-known fact among staff nurses that many of those in nursing leadership do not belong in their positions and that many in hospital or facility administration don’t belong there ether. Whether it is a lack of education in organizational leadership or a lack of experience, many nurse managers and administrators have difficulty dealing with day-to-day issues let alone bullying on a unit or within the facility. It is also well-known that managers often ignore policies on bullying because they feel that they are ineffective or that bullying itself is not an issue.

Many nurse managers unfortunately see their staff only as employees there to get a job done. Staff presence or absence affects patient care and the bottom line. The victim is not seen as a person with rights.

Nurse leaders should:

  • Receive evidence-based education regarding bullying, incivility, and workplace violence.
  • Be aware of their own actions and words…are they a bully?
  • Name the action of a perpetrator as “bullying” or “horizontal violence” – get it out in the open and freely expressed.
  • Take the opportunity of staff meetings to speak on the issue. Use this as a teaching moment and to express that bullying will not be tolerated.
  • Ensure that there exists facility policies in place to deal with bullying, and if not, be a part of team that creates them.
  • Be fully committed to eradicating bullying from a unit/facility.
  • Avoid moving a bully from unit to unit in order to avoid removing a productive employee. This sends a signal that bullying is condoned.
  • Create and enforce a culture of respect.
  • Immediately acknowledge staff concerns and complaints, but act on sincere, accurate information.
  • Actively listen to concerns of staff.
  • Be on the lookout for the formation and existence of cliques.
  • Ensure that self-governed staff decisions are fair, accountable and responsible.
  • Be supportive of all staff.
  • Ensure that those staff that precept students or new staff are educated as to how to do so.
  • Be fair and consistent in dealing with all staff.
  • Be aware, at all times, of unit culture – has anything altered the emotional atmosphere of the unit? Be aware of morale.
  • Be sympathetic and empathetic.
  • Be a champion of open communication.
  • Be supportive of those continuing their education.
  • Don’t blame the target of a bully.
  • Ensure that staff are accountable for their actions.
  • Encourage assertiveness, discourage aggression.
  • Ensure adequate, safe staffing levels.
  • Make bullying victims aware of employee assistance programs.

Margaret Ciocco

Maggie Ciocco MS, RN, BC, is currently a nursing program advisor for the W. Cary Edwards School of Nursing at Thomas Edison State University in Trenton, New Jersey. She has over 25 years of experience in nursing education, including as a preceptor, mentor, staff development instructor, orientation coordinator, nursing lab instructor, and clinical instructor. Ms. Ciocco received her master of science in nursing from Syracuse University, her bachelor of science in nursing from Seton Hall University, and her associate degree from Ocean County College in Toms River, New Jersey. She has been an American Nurses Credentialing Center board-certified medical-surgical nurse for over 20 years. Throughout her years as an educator, she has established preceptorship programs in acute, subacute, and long-term care settings. She is a member of the National League for Nursing. Ms. Ciocco was awarded the Sigma Theta Tau-Lambda Delta chapter Hannelore Sweetwood Mentor of the Year award in 2012. As a nursing program advisor, she works with Registered Nurses and student nurses as they continue their education, mentoring and advising them as to career and nursing degree choices. She is the author of Fast Facts for the Medical-Surgical Nurse: Clinical Orientation in a Nutshell, published by Springer Publishing Company in 2014 and Fast Facts for the Nurse Preceptor: Keys to Providing a Successful Preceptorship in a Nutshell published by Springer Publishing Company in 2016 and for release in summer of 2017 Fast Facts on Combating Nurse Bullying, Incivility and Workplace Violence: What Nurses Need to Know in a Nutshell.

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