How can we change the bullying culture in nursing?

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Why do nurses bully each other and how can this be changed? Belinda Mikaelian is a clinical nurse specialist who recently co-wrote a paper with David Stanley titled ‘Incivility in Nursing: from roots to repair’. Originally from a cardiac/cardiothoracic and vascular background, Belinda has moved into pain management and is currently studying for her Masters in Nursing. She tells Nurse Uncut ‘I would love the opportunity to help make a culture change in nursing’.

Belinda writes: ‘Nurses eat their young’. We have all heard those words before. Sadly, it’s not only nursing staff that recognise this, but the general public. Nursing is the most trusted profession, but not with their own well-being.

Theories

There are theories as to why nurses bully. The one that sits the most convincingly with me is that bullying is deeply ingrained in a culture that was created way back when nurses were an oppressed group. Oppressed by cause of being female. Oppressed for being under the direction of doctors. As time has passed, the oppression has lifted, but the culture of an oppressed group has not and remains part of our identity as nurses. But what does an oppressed group look like? Generally, people in such a group will turn on each other to feel superior, because they don’t like being the same as the others. And once they have turned on their peers, then they never quite fit back into the group comfortably, which only perpetuates the tension.

Bullying effects more than just the victim. It effects how our teams or wards function, the organisational goals and patient outcomes. At a time when nurses are needed more than ever, we are forcing many out the door by virtue of uncivil behaviour.

Belinda MikaelianPersonally, the reputation has never sat well with me. I could never understand how a group of amazing professionals who work so hard in a caring role can turn on each other in such a way. Imagine the job satisfaction of going to work knowing you didn’t have to deal with a colleague undermining you, rolling their eyes as you talk, making uncivil comments behind your back or disciplining you inappropriately in front of others. Imagine how productive you could be if you didn’t have anything working against you other than your patient load. Imagine if you felt supported by all of your team members.  [Belinda Mikaelian, right.]

So, if this problem is so deeply ingrained or embedded in nursing culture, how can we change it? What can we do to make a difference? The answer is more simple than you would have imagined.

First steps

By recognising that bullying exists and is very harmful, we have taken the first step toward change. From there, it is important that we address the issue as it arises. This could be in a more structured way, such as a focus group, or in a smaller context on a personal level, by just addressing the behaviour as we see it. By using straight talk, we could let the person know that we don’t think it’s okay when they speak behind someone’s back or roll their eyes when that person is talking. If enough people address the issue, then it is no longer normalised or accepted and the perpetrator has to change their behaviour. The truth is, bullying exists because we just accept it as a fait accomplit. The way forward is by challenging that in everyday interactions. It may take a little self-reflection to ensure we are not contributing to the problem. It may take a little courage to speak honestly and respectfully to the person perpetrating the act. It may take conviction in the cause to change this dangerous culture.
Clinical leaders are in the best position to be able to address these issues. Not managers. Not the organisations. We all know that organisations are well equipped with policies to stop bullying, but they are in essence trying to catch the act with a net, not recognising its fluid nature. Despite all best intentions, bullying still exists. This is a problem best fought from the grassroots up.

Change leaders

Clinical leaders are those people we work with day in and day out who model the traditional nursing values. A congruent leader is a clinical leader whose actions are congruent with their beliefs and values. These people will barely recognise that they are considered leaders at all and on reflection, of the people I work with I could point out at least five or 10 on each ward. Chances are, if you are reading this, you are a clinical leader! Your role in change is essential. Don’t underestimate that.

Each and every one of us has the ability to make a difference in our workplace and work culture. We are a product of what we accept as normal and acceptable. We are all capable of changing the culture of bullying one act at a time. Stand up, stand proud and encourage others to do the same. Step by step we can change the culture of this profession to be one we are proud of, one that is congruent with caring and one we can all be happy to work in.

Belinda is the lead author on:

11 COMMENTS

  1. As a victim of bullying by colleagues on several occasions, one leading to a deep depression, I was very impressed with this article.
    I work in mental health and bullying is rife! One of the problems I’ve observed was that bullying is at management level and filters down.
    Even now I am a casual working in a job I love, but not a day goes by that I am not put down or embarrassed in front of others. I am well aware of eye rolling from some when I speak in handover and clinical reviews, which eventually impedes your confidence. There are at least two colleagues that make it very apparent they do not like me at all. This has been apparent from the day I commenced work there. I have had no exchange of words, I haven’t had any form of altercation in any way with anyone. Some people just decide they don’t like you. I fail to understand this.

    One day I was with a colleague after we had just interviewed a client together. We were walking down a corridor and my colleague wanted to call in at the NUM’s office to talk with her briefly. I had to stay with her as I didn’t have a swipe to leave that part of the building. I was standing at the doorway as she spoke to the NUM. The NUM wanted to know who she would be working with that evening when she did overtime. My colleague told her it was me. The nurse didn’t see me standing in the doorway. To my horror and embarrassment she sarcastically laughed, rolled her eyes and said “Oh my god are you serious” and said my name. I was so embarrassed. I thought what would give her reason to talk about me like that. My colleague didn’t say a word. This made me feel really sad.

    I haven’t done anything to earn such contempt other than be courteous, a professional and team player.

    I seriously could go on and on with experiences I have had throughout my career. It sounds like an exaggeration but everywhere I have worked I have experienced bullying on some level. I noticed when I used to work on a ward environment, the graduate nurses were exposed to this culture in the immediate beginning of their careers. Therefore it is being instilled into a nurse from day one. I think integrating workplace bullying into the curriculum in the Bachelor of Nursing would be one way of addressing it. For nurses already in the workplace I feel an independent body separate from your workplace and HR. Serious consequences should be put in place for bullying.

    What are the statistics on nurses who have committed suicide due to workplace bullying? I would love to hear other nurses’ comments and experiences.

  2. It would be interesting to know if male nurses were subjected to the same bullying – being an older nurse I would not know.

  3. I have witnessed bullying of males but I think it is more prevalent in females, just from my observation. I am not a younger nurse either!

  4. I have been a victim of bullying in aged care. It’s no use complaining as nothing ever gets done, always better to leave. I’m now doing agency and will never go back to a permanent role anywhere. I’m leaving the nursing field at the end of the year and I’m delighted.

    • That is really sad! I have had the same thoughts myself. I truly loved being a nurse, but the treatment I have received from colleagues and management has been disgusting. It is a real shame as I know I am a good, kind nurse and good at what I do. I am sure you are the same. But I question myself often, do I have to tolerate this until the end of my career? I still have 20 years of working left. Bullies don’t care how old you are or your personal circumstances either. I don’t know how this will be resolved for nurses of the future.

  5. I don’t think it’s about being oppressed any more, I think a lot of nurses are unhappy and insecure and take it out on other nurses because if they took it out on other health workers or patients, they wouldn’t get away with it. I also think some nurses have an inflated view of their own importance – don’t get me wrong, nurses at all levels have a hugely responsible job and should be respected, however we’re all just cogs in a machine who can be replaced at some point.

    I’ve read about toxic cultures in disability, charities and HR – nursing is far from being the only human service occupation which suffers from it. I can never figure out if looking after people and being expected to be endlessly kind and considerate takes its toll or whether these types of occupations attract bullies because they think they can get away with it … or maybe a bit of both.

    I’ve experienced bullying when I was a younger nurse and tried being direct, defended myself, went about my work, ignored it … sometimes these things work, sometimes they don’t. The point is, nobody wants to go to work constantly having to figure out strategies on how to deal with jerks, it’s exhausting. It’s not that hard to behave yourself at work, yet some people never leave high school.

    I changed occupations some time back and haven’t had any problems with my colleagues since nursing. I’ve never regretted leaving.

  6. I am one nurse on a mission to end bullying after becoming a victim, with no one to even listen.
    Problem too big for those who fear losing their jobs. But after losing everything I’ve nothing left to lose … I’ve begun with the IRC.

  7. Bullying does not just happen in the real world of nursing. As a nursing student, I was bullied by my clinical facilitators and even my lecturers. I am not exaggerating anything here.

    I quit in my very final semester of my Bachelor of Nursing course. Some people may think I am stupid to make such a decision. I never regret doing that.

  8. My friend is a Muslim.
    I recently had the good fortune to work with a very capable, hard working & infectiously happy colleague. We were sad to see her move to a hospital closer to where she resides. I admired her strength & devoutness with her faith. I was saddened to hear that she has been subjected to baited conversations around the subjects of terrorism & customary clothing in her new workplace. Some of the racist comments, which impacted on her, were from quite senior health professionals. This type of behaviour is not “just a bit of harmless fun” but an undermining of our common humanity.
    I have grown up in a country that has been inhabited for 60,000 years. Quite recently (in the last 228 years) this large island came under the control of a Christian European society from which I am descended. My descendants had bigger weapons, which facilitated this domination. For me it’s been a comparative & lucky privilege to be born into this society. However I don’t feel anyone has an inherent right to denigrate people who were by chance born into other cultures.
    The devastation facing Muslim people currently is starkly emphasised by their high representation in the 60 million people fleeing their treasured homes around our planet. Complex decisions to seek asylum must be so difficult.
    Christians have had their fair share of extremists that I in no way support. I sympathise with those who practice Islam only to be unjustly labelled a terrorist supporter. I’m convinced that most humans believe that violence perpetrated in the name of religion is wrong no matter what their cultural upbringing.
    In the health industry I see the obvious benefit of teamwork amongst people from diverse backgrounds. I have had great fortune to be able to backpack & meet so many interesting people. Clearly now the world has come to me via immigration to form a rich & interesting tapestry in my workplace.
    I think that listening to my diverse colleagues’ life stories enriches my life. How can we ever understand someone that we marginalise? I’m privileged to be able to identify myself on this issue without fear of repercussions & hope that those from minority groups are confident to use this NURSE UNCUT forum (anonymously if they choose) to seek justice in their workplace.

  9. That statement, “nurses eat their young”, should not be used at all; for me, it gives permission to bullies to continue bullying others and it comes across as a justification of behaviour that should not be tolerated at all!

  10. I was bullied by two senior nurses on my very first day as a new graduate nurse. It set the precedent for what was to come.
    It is truly disgusting how nurses treat one another.
    Two words. Power trip.

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