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? Clinical Nurse Specialist and researcher Belinda Mikaelian gives her thoughts on this age old issue. 

‘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.

Personally, 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.

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 Incivility in Nursing: from roots to repair

This article was re-published as part of a series for World Day of Bullying Prevention. 

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