Creating a No Bullying Unit Environment Jeanette Miller NGR 6725 November 21, 2016

Bullying in the workplace. How Bad Can It Be? More than 65 million U.S. workers are affected by workplace bullying. This is equivalent to the combined population of 15 states. Over 72% of the employers either deny, discount, encourage, rationalize, or defend workplace bullying. (Fink-Samnick, 2015)

Can the numbers be any higher? Even with such high numbers, workplace bullying is still underreported. 40% of those who are bullied never report it to their employers. Bullying wrongly seen as just a conflict or a difference in personality styles. Fear of retaliation or reprisal. Feeling of embarrassment. Have low confidence or self-esteem. Assumption that no one will believe them. (“Why U.S. Employer,” 2007; Akella, 2016 )

But, nurses are above this, right? Healthcare has one of the highest levels of bullying with the most common form occurring between nurses. A survey of more than 4,500 health care workers found that 65% reported disruptive behavior among nurses. For new nurses, incidences of bullying are higher with more than 90%, of those with 3 years or less of experience, having reported being bullied by their nursing peers. (Gilbert, Hudson, & Strider, 2016; Fink-Samnick, 2015; Castronovo, Pullizzi, & Evans, 2016)

WOW. So, what exactly is workplace bullying? Workplace bullying has been defined as a “repeated hurtful negative act or acts (physical, verbal, or psychological intimidation) that involve criticism and humiliation to cause fear, distress, or harm to the individual (i.e., victim).” (Akella, 2016)

What are examples of bullying behavior? OVERT Yelling or shouting; exhibiting anger or aggression verbally or non- verbally; persistently disparaging someone or their opinions, ideas, work, or personal circumstances; embarrassing, degrading, or humiliating someone publicly in front of others; communicating offensively by using profanity, demeaning jokes, untrue rumors or gossip, or harassment; or impeding someone’s progression within an organization COVERT Ignoring, avoiding, or not paying attention to someone; removing someone’s responsibilities, changing their role, or replacing aspects of their job; setting impossible expectations or changing expectations to set someone up to fail; giving unfair assignments; or withholding information (Click to Play) (“Employer Resource Council, 2013; Vickers, 2014 )

Who are the bullies? BASED ON GENDER (“U.S. Workplace Bullying,” 2014)

Who are the bullies? BASED ON RACE (“U.S. Workplace Bullying,” 2014)

WHAT ARE THE EFFECTS? Some have considered workplace bullying to be a “more crippling and devastating problem for employees than all other work-related stress put together.” The effects on one’s health and well-being include increased levels of depressive and anxiety symptoms, psychosomatic health complaints, and psychiatric pathologies. Concerning professional-organizational effects, bullying can lead to burnout, low morale, decreased job satisfaction, an intention to leave the organization, higher sick leave and absenteeism, increased turnover, and reduced productivity. (Waschgler, Ruiz-Hernández, Llor-Esteban, & Jiménez-Barbero, 2013; Akella, 2016).

What about the effects on nursing? Patient safety is threatened due to a failure in communication and collaboration. A study of 4,539 healthcare workers, found that: 67% felt there was a linkage between bullying and adverse events, 71% felt there was a linkage with medication errors, and 27% felt there was a linkage with patient mortality (Click to Play) (Longo, 2010)

How can we create a no bullying unit environment? Devote resources to establishing a culture of inclusion and respect. ZERO TOLERANCE Adopt a zero-tolerance position on bullying behavior. Develop a code of conduct that describes disruptive behavior and the consequences for engagement. Must address all staff. Must be applicable in all situations. Must encourage staff to inform their managers when they or some else is being bullied. Must celebrate and reward those who show exemplary behavior. (Longo, 2010)

How can we create a no bullying unit environment? AWARENESS AND EDUCATION Educate managers on the root causes of bullying and on how to maintain and strengthen the psychological contract between employers and employees. Educate staff on the impact of bullying behavior, how to manage conflict, how to effectively communicate, cultural awareness, and team building. COMMUNICATION Develop more open communication and increase access to managers. Ensure that managers are interacting often with staff. Managers must make a conscious effort to get to know each member of the unit. Reducing interpersonal barriers results in staff being more open to sharing their concerns. (Johnson, 2015)

How can we create a no bullying unit environment? LEAD BY EXAMPLE Insist that managers “lead by example, champion respect, and set the tone and expectations for behaviors essential for fostering a harmonious and collaborative environment.” MONITORING Monitoring through the use of satisfaction surveys and anonymous reporting to aid in promptly identifying and addressing bullying behavior. CONSEQUENCES Must show staff that there are real consequences for engaging in bullying behavior. Must ensure fairness and consistency. Failure to establish discipline will render entire efforts of change useless. (“Workplace Bullying and Lateral Violence,” n.d.)

What are the implications for nurse leaders? Nurse leaders are able to effectuate change and must embrace this responsibility. Must educate themselves on bullying and its detrimental effects to become more vigilant. Knowing not only the obvious acts but also the less obvious will help to alert leaders to the subtleness of how bullying behaviors can be presented. Will need to become self-aware of their own behaviors and practices and change those that may be deemed as bullying. Can begin to incorporate practices such as those found in authentic leadership Relationship-focused style of leadership Must become more emotionally intelligent. (Johnson, 2009)

References Akella, D. (2016). Workplace bullying. SAGE Open, 6(1) doi:10.1177/2158244016629394 Castronovo, M. A., Pullizzi, A., & Evans, S. (2016). Nurse bullying: A review and a proposed solution. Nursing Outlook, 64(3), 208-214. doi:10.1016/j.outlook.2015.11.008 Employer resource council: 20 subtle signs of workplace bullying. (2013). Retrieved from http://www.workplacebullying.org/individuals/problem/employer-reaction/ Fink-Samnick, E. (2015). The new age of bullying and violence in health care: The interprofessional impact. Professional Case Management, 20(4), 165-174. doi:10.1097/NCM.0000000000000099 Gilbert, R. T., Hudson, J. S., & Strider, D. (2016). Addressing the elephant in the room: Nurse manager recognition of and response to nurse-to-nurse bullying. Nursing Administration Quarterly, 40(3), E1-E11. doi:10.1097/NAQ.0000000000000175 Johnson,S. L. (2015). Workplace bullying prevention: A critical discourse analysis. Journal of Advanced Nursing, 71(10), 2384-2392. doi:10.1111/jan.12694 Johnson, S. L., & Rea, R. E. (2009). Workplace bullying: Concerns for nurse leaders. JONA: The Journal of Nursing Administration, 39(2), 84-90. doi:10.1097/NNA.0b013e318195a5fc Longo, J. (2010). Combating disruptive behaviors: Strategies to promote a healthy work environment. Online Journal of Issues in Nursing, 15(1), 1E. U.S. workplace bullying survey. (2014). Retrieved from http://workplacebullying.org/multi/pdf/WBI-2014-US-Survey.pdf Vickers, M. H. (2014). Towards reducing the harm: Workplace bullying as workplace corruption—A critical review. Employee Responsibilities and Rights Journal, 26(2), 95-113. doi:10.1007/s10672-013-9231-0 Waschgler, K., Ruiz-Hernández, J. A., Llor-Esteban, B., & Jiménez-Barbero, J. A. (2013). Vertical and lateral workplace bullying in nursing: Development of the hospital aggressive behavior scale. Journal of Interpersonal Violence, 28(12), 2389-2412. doi:10.1177/0886260513479027 Why U.S. employers do so little. (2007). Retrieved from http://www.workplacebullying.org/individuals/problem/employer-reaction/ Workplace bullying and lateral violence among nurses. (n.d.). Retrieved from https://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work- environment/AMSN-HWE-Bullying.pdf