Do nurses ‘eat their own’? Identifying and managing workplace bullying

By: Kate Blackwood

Reading the article Do nurses eat their own? Identifying and managing workplace bullying and undertaking this learning activity is equivalent to 60 minutes of professional development.

This learning activity is relevant to the Nursing Council of New Zealand competencies: 3.3, 4.1, 4.2.

Learning outcomes

Reading and reflecting on this article will enable you to:

• increase your understanding and awareness of workplace bullying
• reflect on how individuals experience bullying and how your organisation manages bullying
• describe ways that you can contribute to the prevention and management of bullying in your organisation.

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Introduction

Workplace bullying is a known problem in the nursing profession internationally.
If findings from research conducted in the New Zealand healthcare sector¹ are applied to the nursing workforce, it is estimated that approximately 10,000 of New Zealand’s nurses have experienced workplace bullying in the past six months (about one in five), and that over 40,000 (87 per cent) have been exposed to occasional negative behaviours.

The detrimental consequences of workplace bullying extend well beyond those directly exposed. Bullying targets, witnesses, and individuals accused of bullying may experience harmful consequences, such as stress, depression, difficulty sleeping, low self-esteem, post-traumatic stress disorder, and suicidal ideation. Workplace bullying lowers morale, job satisfaction, commitment and productivity, and increases the likelihood of staff absenteeism and turnover.

In the nursing profession in particular, workplace bullying has detrimental impacts on workforce productivity and negatively impacts the quality and safety of health services provided to the public.

Bullying in nursing is enabled or encouraged by a range of work environment conditions, such as physical and emotional stress, high workloads, limited resources and community expectations.

A politicised climate is also said to exist in nursing, leading to a lack of collegiality and a climate of nurses “eating their own”².

Bullying is often passed down from experienced nurses, with nurses commonly reporting being exposed to bullying during their training and induction years³. Such exposure to bullying throughout socialisation processes normalises bullying behaviours from the point of entry into the profession, encouraging and embedding a perpetual culture of bullying⁴.
Research in New Zealand shows that newly registered nurses are subjected to bullying behaviours, such as having learning opportunities blocked, being undervalued, suffering emotional neglect, being distressed about conflict, and being given too much responsibility without appropriate support⁵.

However, it is not only junior nurses who are at risk of bullying: bullying can occur anywhere in an organisation.

Identifying bullying

Although a range of definitions exists, it is generally agreed that bullying consists of systematic and persistent behaviours directed towards an individual over a period of time. The definition used by WorkSafe in their good practice guidelines Preventing and Responding to Bullying at Work⁶ is:

“Bullying at work is repeated and unreasonable behaviour directed towards a worker or a group of workers that can lead to physical or psychological harm” (p. 14).

There is a range of behaviours that constitute bullying. These are generally categorised as being work-related, person-related, or physically intimidating behaviours and are outlined in Table 1. (See Table 1 at end of article)

Because of the covert nature of many of the behaviours that can constitute bullying, bullying is often difficult to identify at first.

Also, the definition of bullying is such that it is not until the behaviours have been going on for some time (official measurements of bullying prevalence use a six-month duration⁷) and an individual has been frequently and persistently targeted that an experience would constitute bullying. Hence, the nature of workplace bullying is such that targets of bullying are often unable to identify an experience immediately.

However, as bullying behaviours continue over time, a cycle of demoralisation develops where the individual begins to doubt themselves and their confidence is undermined. In the initial stages of a bullying experience, they will often struggle to make sense of whether they are being targeted or whether they are misinterpreting the behaviours.

A common response by nurses when reflecting on the initial stages of their bullying experience is: “I thought it was all my fault”. At this stage of an experience, the targeted nurse will often seek to re-establish a sense of safety and security, rebuild comfort, and validate their value in their work team.

While a number of studies point to a struggle by those who are bullied to identify that what they are experiencing is workplace bullying, in some cases, the perpetrators may also struggle to identify cases of workplace bullying. Cultural norms can cause individuals to behave in such a way that they believe their behaviour appropriate in their work context, and bullying perpetrators may claim to have little insight into the impact their behaviour is having on the other person.

Coping with bullying

There are a number of strategies that an individual experiencing bullying can use to try to deal with the situation. These strategies can include:

• seeking help
• responding assertively
• avoiding the bullying (for example, by taking leave, seeking a job transfer or asking to be rostered to a different shift)
• ignoring the behaviours and trying not to let it affect them.

Research indicates that junior or low-status employees are more likely to respond by trying to please the perpetrator and not giving them an opportunity to bully than they are to respond assertively⁸.

It is recommended that targets of bullying should be more assertive in dealing with perpetrators to avoid being perceived as easy targets of mistreatment. Several cases of effective coping by responding assertively to the bully have been reported by New Zealand nurses⁹, as in the following quote:

“I decided I wasn’t going to let her bully me. Every single time I spoke back to her nicely, no matter how bad she was, no matter what she said. And from my point of view, it worked. I was amazed. Her attitude towards me started to change.”

It should be noted, however, that targets of bullying who have success using this approach generally also have validation from their managers that they are not in the wrong and are well supported by colleagues.

For many targets of bullying, responding assertively is often easier said than done, particularly when the bully is at a senior level in the organisation or when the experience has escalated and the target has become demoralised and lost confidence.

Indeed, targets of bullying are often forced into positions where they have little power to deal effectively with their own experiences of workplace bullying and, unless the organisation steps in, an unfortunate and all too common outcome is that once the targeted individual’s personal coping resources are depleted they will leave the organisation.

Hence, early identification and reporting is essential for resolving cases of workplace bullying.

Reporting bullying

Most anti-bullying policies will outline the channels for reporting within the organisation.

Generally, nurses who believe they are being subjected to workplace bullying are encouraged to report to their direct line manager in the first instance, if they feel safe to do so. Other reporting channels include other managers, a harassment contact person (if the organisation has them), a union representative, or a human resources manager (HR). Some organisations also encourage reporting by way of lodging an incident report; however, experiences of bullying do not often involve a single major incident and instead the harm experienced is a result of a build-up of subtle behaviours over time. In such cases, incident reporting may not be appropriate.

However, despite being aware of policies and reporting channels, research shows that many targets of bullying do not formally report their experiences¹⁰.
Under-reporting may be due to:

• unclear or unsafe reporting channels
• a perceived lack of support from the organisation
• fear that a complaint will be perceived as unsubstantiated
• fear of retaliation from the bully.

When a target has previously seen other complainants being blamed or seen as troublemakers and having their problems deflected with little or no support, they too become reluctant to complain. In organisations where there is a culture of bullying and it is perceived to be tolerated, encouraging reporting is particularly problematic.

Managing bullying

If a target of bullying makes a formal complaint to HR, they will respond by conducting an investigation into the complaint, interviewing both parties and witnesses, and provide recommendations based on the outcome.

However, targets of bullying often find this process overwhelming and emotionally draining. By the time a bullying experience has escalated to a point that a target believes a formal complaint is warranted, the targeted individual will often feel highly demoralised, having experienced numerous unsuccessful attempts to resolve the situation.

Due to the historical nature of many of the behaviours (with some experiences having continued for years prior to a formal complaint being made), and the contextual nature of the harm experienced (i.e. the build-up of behaviours, rather than a major incident), targets often have little evidence to support a bullying complaint. In addition, perceptions of right and wrong are usually strongly embedded by this stage and neither party is able to compromise on their views. As such, the outcome of workplace bullying investigations is rarely accepted by both parties and for these reasons a number of early, low-level interventions are strongly recommended.

Coaching

The preliminary findings of current research into the competencies required for managing bullying show excellent practice by some New Zealand nurse managers, including providing perpetrators with insights into their behaviours and coaching them in effective communication with colleagues. Coaching the targets in effective responses to bullying can also increase their resilience; however, managers should be aware that relying solely on target-focused responses is rarely sufficient to resolve a case of workplace bullying and is unlikely to be suitable in escalated cases or when there is a power imbalance between the target and the alleged perpetrator.

Mediation

Mediation is also a commonly used strategy for resolving cases of workplace bullying and can be conducted formally by an external mediator or by a manager or organisational representative. The efficacy of mediation for resolving cases of bullying is debatable; however, it is generally agreed that in escalated, highly destructive cases of bullying or where the alleged perpetrator is a manager, mediation is less appropriate due to the power imbalance that exists between the two parties. Although mediation is not recommended in such cases, if such a case does go to mediation, encouraging the target to bring a support person or advocate is advised.

Importance of managers’ skills and awareness

Although there is evidence of good practice by managers and organisational representatives in responding to workplace bullying, ineffective intervention in workplace bullying is common. If the bullying intervention is not effective, the target is often left with little choice but to leave the organisation. Research indicates that unsuccessful resolution is often due to:

• lack of managerial confidence and skill in dealing with complaints
• lack of time
• managers believing that conflict between staff is not their responsibility.

In cases where the alleged perpetrator is a manager, managers have been found to be able to justify their behaviours as performance management, and HR may often side with management. That said, however, staff may also use the term ‘bully’ in an allegation of managerial bullying as a response to legitimate performance management that they deem is unfair.

It is well-documented that effectively resolving escalated cases of bullying is near impossible, and therefore it is strongly recommended that early identification of potential cases of bullying and early reporting and intervention is encouraged.

Organisational culture

Although line managers hold the role with most influence on the immediate work environment – and are often heavily relied upon to address behavioural issues within their team – the support of the organisation is also required to address an underlying culture of workplace bullying. While it is commonly recommended that an anti-bullying policy is developed and implemented by organisations, research indicates that a policy alone is unlikely to have a significant impact on the prevalence of workplace bullying and multi-level interventions are required.

Organisations should work to minimise work-related causes of bullying, such as role conflict and ambiguity, poor leadership, and institutionalised processes and practices that encourage bullying.

A strong zero tolerance for bullying should be communicated and enforced by senior leadership and commitment to this policy demonstrated through frequent communication and resourcing of interventions. Organisation-wide culture change programmes aimed at fostering dignity and respect in the workplace are also encouraged¹¹.

Bullying intervention recommendations include:

• training staff and managers to identify and report bullying
• training managers to deal with bullying
• building leadership competencies
• ensuring senior management and organisation commitment to addressing bullying
• programmes/initiatives aimed at culture change
• minimising risk factors in the work environment that contribute to the proliferation of bullying.

Risk factors for workplace bullying include:

• unclear organisational change processes
• role ambiguity and role conflict
• destructive or laissez-faire leadership
• hierarchical structures and reward systems that encourage sabotage
• highly stressful work environments and high workloads
• socialisation/induction traditions
• cultures of tolerance and acceptance of bullying.

Are you a bystander?

Witnesses to bullying have been acknowledged as playing an influential role in shaping the bullying experience and its resolution.

Witnesses can influence a bullying experience in a number of ways¹². Those who associate themselves with a nurse clique may be more inclined to assume an instigating, manipulating, collaborating or facilitating role, whereby they encourage the bully or create situations for the perpetrator to go after the target, often for their own personal benefit. Alternatively, a witness may take an intervening, defusing, empathising, or defending role, whereby they actively support the target.

Unfortunately the most common role assumed by witnesses is one of abdicating or avoiding, whereby they allow the perpetrator to continue bullying, or simply walk away from the situation. Witnesses to bullying often fail to speak up at the time of an incident, often choosing to support the target behind closed doors instead, for fear of retaliation from the bully.

Although the prevalence, causes and consequences of workplace bullying are reasonably well documented, the search continues for effective strategies for prevention and intervention. Therefore the problem continues to persist and cases of bullying are rarely resolved effectively.

However, early identification and low-level interventions prior to escalation are vital if cases are to be resolved.

All staff within an organisation should be encouraged to familiarise themselves with the behaviours that can constitute bullying, report behaviours early, and stand up for colleagues experiencing bullying. Organisational support and a zero-tolerance culture of bullying are also required to put a stop to this pervasive problem.

View the PDF of this learning activity here>>

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Table 1: Bullying behaviours

Work-related

• Someone withholding information that affects your performance.
• Being ordered to do work below your level of competence.
• Having your opinions ignored.
• Being given tasks with unreasonable deadlines.
• Excessive monitoring of your work.
• Pressure not to claim something to which by right you are entitled.
• Being exposed to an unmanageable workload.

Person-related

• Being humiliated or ridiculed in connection with your work.
• Having key areas of responsibility removed or replaced with more trivial or unpleasant tasks.
• Gossip and rumours being spread about you.
• Being ignored or excluded.
• Having insulting or offensive remarks made about your personality, attitudes or private life.
• Hints or signals from others that you should quit your job.
• Repeated reminders of your errors or mistakes.
• Being ignored or facing a hostile reaction when you approach.
• Persistent criticism of your errors or mistakes.
• Practical jokes being carried out by people you don’t get along with.
• Having allegations made against you.
• Being the subject of excessive teasing and sarcasm.
• Being shouted at or being the target of spontaneous anger.

Physically intimidating

• Intimidating behaviours, such as finger-pointing, invasion of personal space, shoving, blocking your way.
• Threats of violence or physical abuse or actual abuse.

Source: Negative Acts Questionnaire – Revised⁷

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Recommended resources

• WorkSafe’s Good Practice Guidelines Preventing and Responding to Bullying at Work contains a range of useful tips for targets and organisations in preventing and responding to workplace bullying. https://worksafe.govt.nz/the-toolshed/tools/bullying-prevention-toolbox
• WorkSafe’s Quick Guide Bullying at Work: Advice for Workers provides useful tips for targets and alleged perpetrators of bullying. https://worksafe.govt.nz/the-toolshed/tools/bullying-prevention-toolbox
• The NZNO website contains a range of information on workplace bullying and what you can do about it. www.nzno.org.nz/bullyfree
• Australian conflict coach Judith Herrmann in her 2012 article compares conflict coaching and mediation and discusses the most suitable service in a given conflict situation.
  https://researchonline.jcu.edu.au/26122/1/A_comparison_of_conflict_coaching_and_mediation_-_article_from_ADRJ.pdf
• Bullying targets needing wellbeing support: can approach their employer’s EAP (Employee Assistance Programme) if they have one, talk to their health professional or access free support services like Need to talk? (Free call or text 1737 any time for support from a trained counsellor), Lifeline 0800 543 354 or Samaritans 0800 726 666.

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About the author

Kate Blackwood PhD is a lecturer and a member of the Healthy Work Group at Massey University, Palmerston North. Her recent research projects include exploring target experiences of workplace bullying complaint resolution, the efficacy of mediation in bullying cases and management competencies for fostering healthy work.

If you are interested in reading further on the research that informed this article,
email k.blackwood@massey.ac.nz.

This article was peer reviewed by:

Stacey Wilson RN PhD is a senior lecturer at Massey University’s School of Nursing. Her research expertise includes mental health, crisis interventions and emotional competence.

Mikaela Shannon RN BN MN is a nurse manager at Capital & Coast District Health Board. She has a special interest in fostering respect, kindness and dignity between nursing staff and initiated and leads a Care with Dignity project at Kenepuru Hospital.

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References

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   www.worksafe.govt.nz/worksafe/toolshed.
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