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The Nurse Conundrum — Show Kindness to Patients, Act Awful to One Another

The Nurse Conundrum — Show Kindness to Patients, Act Awful to One Another

There’s a puzzling conundrum in the world of nurses and nursing that’s difficult to reconcile because most nurses are kind, caring, and compassionate with their patients but horrid in their treatment of other nurses. Backbiting, bullying, and otherwise ill-treatment are so common that it’s hard to imagine that a profession steeped in healing could be rampant with a scourge of unkindness and incivility. And yet here we are.

Nurses and the Ethos of Kindness and Compassion 

Ask anyone about nursing; healing and empathy will be at the top. The Gallup poll  repeatedly proclaims our trustworthiness and honesty, and many nurses receive praise for their choice of profession, even from perfect strangers.

Of course, we also periodically hear stories of a patient feeling mistreated by a crusty, burned-out battle-axe of a nurse — yet, overall, most patients likely have a story to tell of a nurse who went above and beyond.

“Nurses can be so caring and compassionate to their patients but cruel to each other,” states Dr. Renee Thompson, CEO and founder of the Healthy Workforce Institute, an organization that works with healthcare facilities with troubled workplace cultures and ingrained problem behaviors among their staff.

In light of these realities, if an ethos of kindness and compassion is a throughline that informs the majority of the care that nurses perform and how others view nurses, what about the profession causes its members to treat one another so poorly?

Nurses and Internalized Oppression

Theories have been suggested regarding why nurses commit bullying and maltreatment (aka horizontal or lateral violence). Internalized oppression is a psychological phenomenon that occurs when group members perceive themselves as oppressed by forces beyond their control and direct their frustration at their members.

In a 2012 paper published by the University of San Francisco School of Nursing and Health Professions, a picture is painted of the origins of nursing’s sense of oppression:

“Nurses are among people thought to be oppressed. The historical premise for this argument is that their practice is dominated by forces outside of the profession with higher status and power. In the late 1800s and early 1900s, women cared for patients in exchange for nurses’ training in hospitals. The male physicians and administrators who ran those hospitals served their own interests by receiving remuneration for the nursing care provided by the women with little or no compensation to the women. Furthermore, nursing practice was labeled the work of women, and the care they provided in the process of their work was valued less than services rendered by male physicians.”

If internalized oppression is potentially at the root, this points to the need to address these issues more robustly in nursing education, the workplace, and the nursing literature.

A Culture of Safety is Possible

“There is an epidemic of bullying and incivility in healthcare that not only affects morale and turnover but also affects patient outcomes,” Dr. Thompson recently shared.

She continues, “The problem is that healthcare organizations aren’t doing a good job of making sure their employees are equipped with the skills and tools they need to confront disruptive behaviors and oftentimes fail to set behavioral expectations from the beginning.”

Recent research published by the National Library of Medicine suggests that different domains of intervention are needed, including:

  1. Preventing future acts of bullying.
  2. Stopping incidents as they happen.
  3. Promoting others to act in the face of bullying based on fostering relationships, positive workplace culture, and increased administrative support.

The AMA Journal of Ethics observes that everyone is responsible for addressing these issues. They also state that healthcare organizations must “outline steps for individuals to take when they feel they are a victim of workplace bullying; provide contact information for a confidential means for documenting and reporting incidents; and establish procedures and conduct interventions within the context of the organizational commitment to the health and well-being of all staff.”

The AMA concludes, “When well-functioning professional teams are partnered with health systems with shared goals and values—and when leaders are committed to building systems that make it easy for team members to do the right thing—a culture of safety is possible.”

No matter which interventions we choose, confronting these behaviors contributes to employee retention, improved workplace culture, safe and efficient patient care, and even fewer medical errors.

A Broad-Spectrum Problem

The mismatch between how nurses treat one another and how they treat their patients is a puzzling irony. We may be perplexed, frustrated, angry, or sad, but the response we cannot afford is apathy and non-action.

Disruptive nurse behavior and the resulting negative workplace culture is a broad-spectrum problem needing a multifaceted response. As the AMA so aptly put it, everyone is responsible, and that responsibility is crucial to honor.

With more members of the nursing profession on board and more proactive responses by healthcare leaders and executives, these unhealthy and toxic workplace behaviors can be identified, documented, boldly addressed, and removed like so many weeds in an otherwise healthy garden simply waiting to bloom happily.

Gen Z Nurses Report Struggles with Stress, Trauma, and Workplace Violence

Gen Z Nurses Report Struggles with Stress, Trauma, and Workplace Violence

On Tuesday, the ANA American Nurses Foundation (the Foundation)  released new survey findings from nearly 12,000 nurses nationwide, revealing that younger nurses are struggling more with mental health challenges and that nurses are experiencing an increase in workplace violence as the nation enters year three of the COVID-19 pandemic.

Mental Health and Workplace Violence

Nurses’ mental health and well-being has been and remains a pressing issue, with the ongoing stressors of the pandemic taking a significant toll on younger nurses. Nearly half of nurses surveyed under age 35 said they have sought professional mental health support since March 2020. Of the survey respondents under age 25, 69% say they have been suffering from burnout, which is more than double than those older than 25 (30%). Additionally, nurses under age 25 (47%) and nurses between 25- 34 (46%) consider themselves as being not or not at all emotionally healthy compared to nurses over the age of 55 (19%) and were more likely to have experienced an extremely traumatic, disturbing, or stressful event due to COVID-19. The number of workplace violence incidences against nurses are on the rise, according to the survey. Specifically, 2/3 of nurses surveyed said they have experienced increased bullying at work while 1/3 of nurses report increased incidents of physical violence at work.

“Mental health challenges endured by nurses is a serious ongoing dilemma that will have long-term impacts on the profession as this younger generation of nurses have been hit the hardest, as noted in the survey. As we think about the future of nursing, this is particularly disturbing because nurses are our most valuable resource in health care, remaining a constant force in the recovery efforts to end this relentless pandemic by administering COVID-19 vaccines, educating communities, and providing safe and quality patient care to millions. The key to ending this pandemic is having and sustaining a robust nursing workforce operating at peak health and wellness,” said Foundation Board of Trustees President, Wilhelmina M. Manzano, MA, RN, NEA-BC, FAAN. “The Foundation continues to be committed to providing resources and the necessary support to all nurses through the Well-Being Initiative and the Coronavirus Response Fund for Nurses. We need to ensure nurses are consistently and completely protected and supported. There is too much on the line.”

Lack of robust support systems feeds staffing crisis

Among respondents who say that their organization is experiencing a staffing shortage (89%), more than half (53%) say that it is a serious problem. Younger nurses are leaving their current positions and roles in increasing numbers. According to the survey findings, nurses ages 25-34 and 35-44 were more likely to change positions than nurses over age 55. Similarly, 60% of nurses under age 25 and 57% of nurses 25-34 do not believe their organization cares about their well-being and generally feel unsupported. The lack of support and work negatively affecting their mental health and well-being were major contributing factors to this sentiment of younger nurses who were more likely to experience negative and unhealthy emotions.

“As we enter the third year of this incessant pandemic, the survey findings are even more alarming than what we found in the survey done last year.  It’s extremely disheartening that we are still seeing and hearing about the same issues nurses have been burdened with since the start of the pandemic in 2020,” said Foundation Executive Director, Kate Judge. “Nurses are still struggling with mental health issues, feeling unsupported, and suffering from severe burnout and post-traumatic stress because of their sustained response to the COVID-19 pandemic. The nurse staffing shortage has had a domino effect on the profession and it’s only going to worsen if we don’t address the chronic, underlying work environment issues. The Foundation continues to work tirelessly on behalf of the nation’s nurses who deserve our full support and respect for their efforts in improving public health and pulling our nation out of the grip of this pandemic.”

Nurses cannot solve the longstanding challenges facing the profession alone. It is imperative that the Administration and all other stakeholders utilize all available authorities to address these issues and collaborate with nurses to forge a path forward to ensure a strong nursing workforce now and in the future.

The full survey results and findings are available online (PDF).

*Data collected through a non-incentivized survey administered by the American Nurses Foundation. Between January 8 – January 29, 2022 – 11,964 nurses completed this survey. *

5 Tips for Managing Workplace Bullying

5 Tips for Managing Workplace Bullying

On a typical workday in the hospital, I was chatting with my coworker (a physical therapist who we’ll refer to as “Robin”) about taking a continuing education class together. Robin wanted to earn some extra income, and she felt the training she’d get from the course would provide her with that opportunity. She was looking for a friend to accompany her to the class and thought I might be interested. I told her I’d think about it and get back to her the next day when we’d both be stuck working the Saturday shift together. Saturday arrived, and with an influx of overnight patient admissions, we were swamped. I’d had no chance to talk with Robin about the continuing education class. When our paths finally crossed, our conversation went something like this:

Me: I’m finished, Robin. I’ll see you next week.

Robin: Aren’t you going to see the patient that just came in an hour ago?

Me: I checked, but there weren’t any orders for occupational therapy. So, I’ll put her on the list for tomorrow.

Robin: Well, you need to see her today!

Me: I can’t see her today. There are no orders.

Robin: Doesn’t matter. But whatever. It’s your head on the chopping block.

Me: I’m not doing anything wrong, Robin. There are no orders for my services, and I can’t see a patient without orders. I’ll see you next week.

When I returned to work the following week, Robin’s whole attitude toward me had drastically changed. She was pointing at me and whispering to others, laughing when I walked passed her, intentionally ignoring me, and not discussing patients’ discharge plans with me. Confused, I kindly confronted her. “Is there something wrong?” I asked her. “Yeah, you,” she responded. “Don’t try to be nice when you talk to me. It’s fake. In fact, don’t talk to me at all.”

I was shocked by her response, but I maintained my composure. Later in the day, I mentioned Robin’s abrupt change in demeanor towards me to my manager. He brushed it off and said, “That’s just Robin.” For the next six months, I endured Robin’s bullying behavior towards me, and I hated going to work. Suddenly, Robin was gone; she’d moved away (thankfully), and we never spoke again. While I never compromised my integrity, I always wished I would have done more to stand up to her bullying in the workplace.

Unfortunately, workplace bullying isn’t as rare as we would like to think, and it’s one of the reasons nurses consider leaving the profession. Below are some tips on how to handle workplace bullying in the hopes that you will be better equipped than I was to handle this challenging situation.

1. Insist that supervisors, managers, and hospital administrators listen to you.

Truthfully, I was embarrassed this happened to me, so I downplayed the seriousness of Robin’s behavior rather than being assertive. Many workplaces have specific policies to address bullying, but those policies can’t be enforced unless your place of employment is aware the problem exists in the first place. While it takes courage to speak up, doing so fosters a culture that says, We don’t tolerate bullying. You may even want to consider filing an incident report.

2. Keep a record of your situation.

Write down your interactions with the bully along with the dates and times the incidences occurred. Also, keep a record of how you handled the situation; you’ll want to try to be as professional as possible, and your documentation should reflect those attempts to maintain a civil working relationship. In the event that you need to present the management with some specifics, your event log can help you do that in a calm and factual manner.

3. Build a support network with your colleagues.

Although being bullied may make you feel like you want to run and hide (and you might need to do that for a few minutes to regain your composure following an incident), one of the best things you can do to feel empowered is to focus on creating healthy relationships with your other coworkers. Having supportive people around you will help you face this situation with greater strength and confidence.

Also, if you are the coworker of someone who is being bullied, speak up on their behalf. Like the old saying says, there is strength in numbers.

4. Prepare yourself in case the situation happens again.

Rehearse what you’re going to say when the bully acts up. Having a few memorized lines will help you feel a sense of control and set a boundary for what behaviors you will and won’t tolerate. For me, I decided that I was going to remain focused on my job despite Robin’s actions toward me. When she tried to attack me verbally, I’d say, “For the sake of the patients in this hospital, I will remain professional towards you.” Then, I’d walk away.

5. If the bully doesn’t quit, you might need to.

If you’ve exhausted all of your options, and your situation doesn’t improve, it could be time for you to consider a new job. Bullying often leads to a spike in physical, emotional, and mental stress, so taking care of your well-being is the utmost priority. No, the bully hasn’t won if you leave. Instead, you’re choosing to find a job in a healthier, more supportive environment.

How to Handle a Nurse Bully

How to Handle a Nurse Bully

Kathy Kump, RN, remembers the first time she was bullied. She remembers the intimidation and disrespect that accompanies such unwelcome acts as early as her first semester. Later, she would encounter it again at the beginning of her career, and even well into her professional journey as she entered into newer positions and ranks. Like many of her colleagues, Kump has been a victim of bullying as a nurse.

Unfortunately, bullying has become all too common in nursing. According to studies, 35% of workers in the U.S. reported having been bullied, while another 15% witnessed workplace bullying.

But there is hope. Understanding why bullying in nursing is rampant and what to do about it can help those effected get a handle on it.

“It Comes with the Territory”

Nurse bullying is so universal that it has its own expression. In 1986, nursing professor Judith Meissner coined the phrase ‘Nurses eat their young’ as a way to encourage nurses to stop bullying new and inexperienced coworkers.

Kump says there are many factors that contribute to the overall cause of bullying in this profession, but sadly the continuing and underlying theme has always been ‘it comes with the territory.’

“Certainly, many of the nurses who contributed to my own early feelings of ineptness or unworthiness as a new nurse most likely experienced the same ramifications when they began their nursing careers,” says Kump, director of nursing at Ottawa University. “Even more disturbing, this negative learned behavior seems to have evolved into a vicious cycle: comparable, in a broader sense, to that of hazing, which was once considered a ‘normal’ ritualistic initiation at some fraternity, sorority, or other group settings.”

The Who Behind the What

The foundational motivation for distinct behaviors of incivility and bullying in nursing may be a reaction to what may be perceived by the profession’s organizational “insecurities” and internal frustrations in the market place. For example, Kump says unlike other health care counterparts in the industry, nurses have struggled to find their “voice” as both a collective and cohesive group, and have grappled with defining their true identity.

Thus, it may be theorized that this superimposed “oppressed” perception contributes to an individual’s sense of powerlessness that may demonstrate itself with unkind words and actions toward others that are seen as less influential and more vulnerable.

“To put it simply and in a real-life context, a nurse may think the following, ‘I can’t take a lunch break because we are short-staffed today and since no one in upper management seems to care, I will take my frustrations out on that new nurse, Sara,’” says Kump.

Call to Action

Kump says whatever the causative factors may be, as long as the nursing profession continues to let this happen, and do nothing about it, it will continue to be a problem for generations to come.

For nurses who may be a victim of bullying, Kump suggests the following:

  • Report it. Any incident in which an employee feels harassed, is made to feel uncomfortable in their workplace setting, and/or bullied should report this immediately to their supervisor. There should be a culture of zero-tolerance for bullying at every organization and all leaders should take this initiative very seriously.
  • Keep composed and maintain the upper hand. Don’t lower yourself or stoop to the bullies’ level. If you feel comfortable and safe in doing so, calmly confront the bully by acknowledging and pointing out the negative behavior and asking them to stop.
  • Be a role model: do not bully others. The negative cycle of bullying will only continue if its victims eventually become the victimizers.