Table of Contents
- Definition of Terms
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- Lateral Violence
- Disruptive behavior
- Culture of Safety
- Verbal Abuse
- Workplace Bullying
- Historical Origin
- Description of the Behavior
- Description of the Aggregate
- Importance of the Issue
- The Problem Statement
- Research question
- Theoretical Perspective for Recommended Intervention
- Recommendations for Nursing
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In the recent times, cases of bullying in the work places have become rampant. This not only affects the morale of the workers, but also the overall output, which in most cases, translates to reduced profitability levels. Smith (2010) argues that, for most multinational companies, the aspect of bullying based on one’s ethnicity, racial background and education among other notable aspects, which results to approximately 15% loss in productivity among the staffs annually. Consequently, these firms have developed tough anti-bullying laws in all their branches globally, thus making staffs to respect one another, regardless oftheir shortcomings. However, it is important to note that, bullying in the health organizations, can be highly detrimental and affects the patients, staffs as well as the general output of the firm. This paper will critically evaluate the aspects of bullying among nurses as well as its effects.
Definition of Terms
Johnston & Jackson (2010) indicates that, bullying is a constant unwelcoming behavior, mostly by re-employing invalid or unwarranted forms of criticism, faultfinding, nit picking, isolation or exclusion among other notable types of vices.
Lateral violence, also referred as the horizontal violence, is used to describe verbal, physical and emotional abuse to the employees. Within the nursing profession, horizontal violence is mainly referred to as nurse-to-nurse aggression and can be manifested in nonverbal or verbal behaviors. The most common types of lateral behaviors in the nursing field includes, verbal affront, non-verbal innuendos, undermining activities, withholding information’s, sabotage, infighting, backstabbing and failure of respecting privacy broken confidences among others (Foster & Natasha, 2004).
This is a behavior that interferes with the effective communication among the providers of healthcare, thus negatively affecting the firms’ performance. This form of behavior does not support the culture of safety (Johnston & Jackson, 2010).
Culture of Safety
This culture is characterized by respectful and open communications among the employees of a health care team with an aim of providing safe health care to the patients. The culture supports commitment of an organization towards an improved safety environment.
This is an expressive type of behavior involving verbal communications, which is associated with bullying and horizontal violence. Foster & Natasha (2004) described verbal abuse as any form of communication that nurses perceives to be harsh and condemnatory attacks upon him or herself personally or professionally. This kind of abuse can include aspects like gossip, backbiting, and passive aggressive behaviors among others.
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Workplace bullying is a tendency of groups or individuals to employ excessive and persistence aggressiveness, or uncalled for behaviors against subordinates or co-workers. This form of bullying can include some tactics, like verbal or non-verbal, humiliations and physical abuse among others. Cooper & Jennifer (2009) argue that this type of aggression is mostly difficult to deal with, because it operates within well-set policies and rules of the society and business.
Foster & Natasha (2004) indicates that going to work should be one of the most fulfilling, productive and enjoyable experiences. This is due to the fact that approximate 70% of time is spent in the work places. It is notable that in healthcare organizations, physicians and nurses among other essential staffs, put in substantial amounts of time to cater for the patients as well as family members who requires a lot of an attention from them. However, workplace violence and bullying has highly threatened their productivity, thus resulting to low productivity in the health care sector. Hutchinson (2008) argues that the culture of healthcare has for a long time been popularized by images of nurses being “handmaidens” in patriarchal environments, thus making the balance of power not to favor the nurses. For those hierarchical organizations, they have been unable to foster the culture of professional collegiality as well as advance on the roles of nursing. In most cases, nurses are acquiesced to the mentality of a victim, which only facilitates the sense of powerlessness (Foster & Natasha, 2004).
Across the globe, nurses have reported concerns focusing on the lack of actions taken by supervisors in addressing the issue of horizontal violence in the workplace (Dellasega, 2009). Cooper & Jennifer (2009) argue that nursing sentiments such as “nurses eat their young” are common, especially in the cases of horizontal violence. Consequently, some vital questions, such as why the nurses eat their young ones, the reason why nurses should not work together to reap the benefits of teamwork that promotes sharing of the ideas, and which makes the nursing professional better among others have been raised (Glenn & Horsfall, 2010).
Johnston & Jackson (2010) discusses that nursing was established in a patriarchal society and is still composed of a greater number of women as compared to men. In 1972, Paulo Freire came up with the term “Horizontal Violence”, in order to explain the conflicts that had been ongoing among the colonized African populations. His observations indicated that imbalance of power results to the formation of the dominant and subordinate groups. Based on this, Sandra Roberts noted that nurses mostly displayed the characters of the oppressed groups, like self-hatred, low self-esteem, feeling of powerlessness, thus applying the theory of Horizontal violence in practice. Foster & Natasha (2004) states that the ideas of nursing as an oppressed discipline, can be traced back to the gender issues and this is substantiated by significant amount of literature. For instance, medicine is a male dominated field, thus making them to oppress the nursing field, which is female dominated. Hutchinson (2008) found that primarily physicians, then the patient’s and their families are the ones responsible for most of the cases of verbal abuse towards the nurses. As a result of this, most nurses indicates that they would consider resigning in response to verbal abuse, which is a clear indicator that they have not been adequately trained to deal with cases of abuse and perceives themselves as powerless to the change organizational response (Cooper & Jennifer, 2009).
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Foster & Natasha (2004) argues that turnovers, which can be attributed to verbal abuse is approximately 24% and 25% for staff nurses and nurse managers respectively. In most instances, hostile environments hinder effective communication channels, which is an aspect that affects the patient safety and quality of health care. This is because, most healthcare professional who face intimidations in the work place may opt to abdicate their advocacy roles, thus hurting on the safety of the concerned patients. In 2004, the Institute for Safe Medication Practices Survey revealed that, experienced nurses, regardless of their gender, were more likely to experience intimidating behaviors among other notable forms of workplace bullying (Hutchinson, 2008). In the recent years, changes in technology, increased knowhow among other notable forms of developments, has continuously placed substantial pressure on nurses, thus propagating the hostility levels of the nursing field across the globe (Cooper & Jennifer, 2009).
Description of the Behavior
Griffin (2004) indicates that bullies within the nursing field exhibits the same characteristics as bullies in any other organization across the world, where their acts are deliberate and aimed at discrediting the intended victims. The bullies tend to be sly and deceitful, thus referred to as “two-faced”. Generally, their acts undermine their intended victims and place them in a disadvantaged position. According to Foster & Natasha (2004), the acts of these bullies take the form of verbal abuse as well as isolation of the victims. Further, the bullies regularly interferes with the victims work places and offer continual sarcasm, fabrication of complaints, criticism and setting the victims up for the failures of intentions among other notable aspects that destroy the confidence of the victims. Johnston & Jackson (2010) indicates that most of these bullying activities takes place behind closed doors, where there are no witnesses, hence making it harder for the victims to litigate. It is important to note that the bullies are fully aware of the damages caused to the victims, and they will continue to do so until they gain full power and control over the victim. For bullying behaviors, the period may vary significantly from months to years (Hutchinson, 2008).
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Description of the Aggregate
Griffin (2004) indicates that in nursing, the aspect of bullying may be demonstrated from peer-to-peer or subordinates to management. In most instances, nurse managers are seen as the principal perpetrators of bulling within this profession, thus indicating that some of the managers lack personal power and making them to misuse the rightful power. This is a factor that leads to an abusive working environment. Such nurse managers, abuse authority relationship due to their individual insecurities, simply identified as poor development in interpersonal skills, inadequate competences and low self-esteem. In some instances, some of the bullying nurses are the ones who were promoted beyond their abilities and experiences, thus making them to feel insecure, intensively concentrating on how to protect their positions and furthering their careers at any expense (Dellasega, 2009).
Some of the factors which enhance the bullying behaviors include difficulties in working conditions, occupational stress, and lack of leadership, unresolved conflicts, and oppression among others. The table below summarizes the different forms of bullying among the various categories of nurses.
v Withholding of crucial information
v Posting of documentation errors on the bulletin boards to be viewed and for others to critique
v Intimidating others nurses by threatening disciplinary procedures
v Writing abusive and critical notes or letters to co-workers
v Verbalizing harsh forms of critique and innuendos
v Employing hand gestures in warding off conversations
v Undermining personal beliefs and values
v Rolling eyes to indicate disgusts
v Using weekend or shift charge positions to control or direct staffs using breaks or assignments
v Controlling the behaviors of co-workers by reporting them to supervisors for them to have perceived lack of assistance and productivity.
v Withholding knowledge and understanding of procedures and policies to get the co-workers in trouble
v Placing others under unwanted pressure for them to meet impossible deadlines and produce work
v Yelling at the co-workers
v Demanding the co-workers to answer a telephone call, NOW!
v Refusal to guide and mentor new staffs in their day-to-day practice
v Refusing to assists employees who struggle with unknown and uncertainties
v Giving public reminder of the incomplete or missed work or documentations.
v Refusing to assists nurses who are in need of assistances
(Johnston & Jackson, 2010)
Importance of the Issue
Randle (2003) found out that of all the types of aggressions, which nurses encountered, whether patient-to-nurse, physician-to-nurse, nurse-to-visitor nurse-to-nurse among others, over 60% nurses indicated that the most distressing form of aggression was that of nurse-to-nurse. It was indicated that, nursing is a women profession, where 50 percent of all the bullies are women, and the women bullies who targets other women is approximately 84% all the time. Foster & Natasha (2004) indicates that such kind of information is vital because bullying within the nursing field takes place between women. The other importance of studying this issue is to help us understand that bullying take place in those organizations, which tolerate violence in work place. A firm that fails to address this issue in time creates a huge problem, not only for the employees and themselves, but also for the victims of this tolerated behavior. As stipulated by Cooper & Jennifer (2009), the victim’s experiences great deal of depression, anxiety and PTSD (Posttraumatic Stress Disorder). This results to loss in ones confidences, sense of worthiness, self-esteem, and reduced belief in ones competency levels.
|Physical effects||Migraines, irritable bowel syndrome, allergies, reduced immune system response, hypertension, cardiac arrhythmias, higher risks of myocardial infarction,|
|Emotional effects||Poor concentration, forgetfulness, loss of sleep, increased fatigue, obsessive, indecisiveness, nightmares, and excessive thinking about the bullies|
Excessive drinking, drug taking, overeating in coping with the anxiety as well as panic that takes place
|Others||Homicide, suicide, premature death among others|
McKenna (2003) found out that, 37% of the health workers had reported one or more form of bullying, of which, 49% was out of abusive language. Foster & Natasha (2004) argues that bullying on the work place can also have adverse effects on ones financial background. For instances, in developed countries, such as the United States, United Kingdom among others European countries, it has been established that at least 13% of staff nurse who suffer bullying in workplaces, ends up litigating these cases (Johnston & Jackson, 2010). This is a costly affair, as one has to finance the litigation charges along other related charges arising due to litigation process. The outcome of bullying can also affect other staffs, especially those who act as witnesses. Cooper & Jennifer (2009) say that most of the witnesses feel sorry about the victim. Consequently, this raises their stress levels in the work place, due to the fear of being a target themselves. Other witnesses are forced to change jobs, work hard to avoid being target and the fear to take actions against the bullies. However, it is important to note that organizations, which allow this kind of behaviors, also pay a significant amount of money and other costs. Some of these costs arise due to the loss of productivity, legal fees, absenteeism, payouts, rehiring, recruitment costs, among others (Griffin, 2004).
In the U.S., it is approximated that it costs between 30,000-100,000 U.S. dollars for every person who is subjected to bullying activities in the work places. The Joint Commission has taken the issue of bullying among nurses seriously, as it affect the quality of health care being offered as well as the security of patients. In 2009, the organization indicated that nursing homes, hospitals, laboratories, ambulatory care facilities, home health agencies, and behavioural health facilities should come up with codes of conducts that determines the type of behaviours to be tolerated and create a formal procedure to manage any form of unacceptable behaviours.
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The Problem Statement
From the discussion above, bullying in the workplaces is being experienced up to date. The literature review clearly indicates that, there exist many aspects of bullying, such as worker worker, worker to client, and worker to management relations (Smith, 2010). Consequently, the problem of bullying as it applies to the nursing profession is a matter that needs to be addressed and proper, sustainable solutions implemented. For this study, the problem of nurse bullying will be stated as follows:
- The aspect of nurse bullying in the nursing profession is still widespread and rampant.
- The purpose of this problem statement is to aid in investigating the nurse-bullying problem and to identify ways of resolving the problem.
- The important considerations include finding ways to enhance good work relations between the parties involved, that is, nurses-to nurses, nurses and patients, and nurses to senior health care staff.
Whose role is it to curb nurse bullying in the nursing profession, is it the nurse’s, patient’s or the hospital’s senior management’s?
Theoretical Perspective for Recommended Intervention
Health organizations are supposed to take proactive steps in protecting the victims of bullying within their institutions (Randle, 2003). It is their mandate to lay down measures to detect any activities that could lead to bullying, as well as to settle disparities between the various groups of workers that form their organizations. In the event where these approaches fail, they should have proper disciplinary procedures against offenders in order to control the menace (McKenna, 2003).
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Recommendations for the Interventions Pertinent to Administrative Practice
Health institution administrators and senior management have a major role in the nurse bullying control. Being the ones in charge of the formation and management of such vital departments as the human resource, they should ensure that there are proper guidelines, procedures and company human resource policy on worker relations and code of ethics. Proper conflict resolution procedures, as well as disciplinary measures should be in place and all workers should be well informed about them (Johnston & Jackson, 2010).
Recommendations for Nursing
The first line of defense for the nurse is to refuse to be bullied. This means, taking a firm stand in situations where the nurse encounters conversations or other behavior meant to bully him/her. Letting the aggressor know that the nurse understands their intention is a bold and it requires effective first reaction (Foster & Natasha, 2004). If the actions persist, the nurse may find it helpful to involve a witness during such confrontations. The nurse may then state clearly and politely that such actions as the bullying partner has taken are offensive to the nurse and that the offender should refrain from them or else the nurse may take further action.
In the event that the approach above is ineffective, the nurse may involve a superior person at work, such as the department head. This is especially appropriate if the case happens at a peer level. However, in the case where a superior person is responsible for bullying the nurse, the best approach would be to use the laid down organization’s human resource policy on inappropriate behavior and involve personnel from the human resource (Glenn & Horsfall, 2010). If the nurse is unable to find support from the human resource department, then he/she may, as a last resort, involve a lawyer. At this point, the matter will obviously have gotten out of control for the institution, and caution should be taken before engaging in major decisions like lawsuits. However, such bold decisions may be inevitable in order to lay a firm non-bullying foundation in the entire nursing fraternity (McKenna, 2003).
The problem of nurse bullying is not only evident, but it is also major in the healthcare institutions (Smith, 2010). Nursing, being such a sensitive profession that involves emotions and care giving, is very prone to bullying. It is the role of all key parties to ensure that they play their part, to minimize, if not, to eliminate this vice that has for a longtime hindered the development of the nursing profession. In my own view, nurses should have sufficient conflict handling skills such as standing firm in a polite manner as they work, and cultivating self-dignity. Moreover, workers should respect each other and nurses managers should give similarly respect their junior staffs.
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