Reducing Bullying in the Nursing Environment

Introduction

Bullying is any repeated and systemic behaviour that expects to victimise, humiliate, undermine or threaten towards others, which can impact on physical and psychological well-being. Bullying has been considered as unaccepted workplace behaviour that affects occupational health and safety, and should not be tolerate in any form (Ref). This paper will provide an analytical discussion of the relevant literature of bulling in nursing environment. Rationale regards to the need of changing management plan will be outlined. The plan will utilise Lewin’s three steps of change theory as a guide to modify the specific phase of change. In addition, it will address the strategies for evaluating the plan outcomes. Finally, this paper will conclude insightfully highlighting main concerns about decreasing bullying behaviour in nursing environment.

Literature review

Workplace bullying exists in every professional. Particularly, bullying in healthcare environment has been internationally recognised and researched. 70% of US registered nurses who participant in a survey reported being bullied at work. 87% of Turkish nurses stated being bullied in another nursing survey (Ref-Barbara S. Broome). In addition, UK health care reported that recent evidence showed 85% of nurses have been involved in bullying or witnessed a bullying (Ref-Malcolm A. Lewis) and (Ref-Sharon J. Stagg) found 40% of participants never reported bullying in their study. (Ref-A typology of bullying behaviours) state that due to lack of descriptive standard to identify bullying behaviours, which leads to less of effective interventions for reducing bullying behaviours. In addition, the absence of identification of bullying behaviours, bullying acts may be commonly interpreted as ‘office policies’ or ‘personality differences’.

The consequences of bullying acts are seriously impact on many aspects, which include nurses, organizations and patients. According to (Ref-Michelle Cleary), the current working environment in health care setting is oriented to maintain safe practices at the meantime also to achieve effectiveness outcomes in day-to-day patients’ care management. Therefore, under this pressure, it is more likely to create a blaming environment. Nurses who work in a climate of bullying may lead to job dissatisfaction, which, in a way that nurses may resist come to work or call sick leave to avoid facing bullies, and present low productivity in the wards. The bulling acts may impact on both physical and psychological wellbeing, which the frequent outcomes for bullying are headaches, stress, irritability, anxiety, sleep disturbance, excessive worry, impaired social skills, depression, fatigue, loss of concentration, helplessness, psychosomatic complaints, and post-traumatic stress disorder (Ref-Michelle Cleary). In addition, the bullied employees from (Ref-LARS JOHAN HAUGE)’s study express that they feel more role ambiguity and conflicts in the working environment, therefore, they have less social contact and communicate with colleagues that leads to poor job control and poor management. (Ref-Terri Townsend) states that up to 70% of bullied nurses leave the job, 60% of new RNs quit their first job in 6 months and a third of new graduate nurses think they choose the wrong career. (Ref-Terri Townsend) also introduce a term – ‘survivor syndrome’, which means bullied nurses would either to quit the job to find another healthier work environment or adapt to the bullying behaviours as part of the culture and become a bully or bystander. When the nurses leave this professional as a result of bullying, the organization has to spend more money for recruitment and re-orientation for new nurses to replace the position. Furthermore, resulting from frequent nursing staff turnover the customer satisfaction will decrease and patients may not get continuous care which may impact on patients’ safety issues (Ref-Michelle Cleary).

(Ref- John S. Murray) expresses that the most common reason of nurses may bully others is the need of being in control of everything in the work environment. (Ref- Barbara S. Broome) also states these bullies are narcissistic. Their personality characterized as controlling and manipulative, which means that they like to dominate in interpersonal relationships. These people are self-centred that indicates low empathy, and they normally do not feel guilt over the time by bullying others. Another point of view from (Ref- Workplace bullying in nursing), they believe the educational system foster a belief that the dominate group (normally are senior staffs) is superior and the oppressed group (normally are new staffs) is inferior, therefore, the inferior has to obtain the demand from the superior. (Ref- John S. Murray) also points out that the organization may connive the bullying behaviours in some cases, due to the bullies are senior managers or staffs. The bullies are protected instead of the victims, which has prompted the bullying behaviours existing in the healthcare environment.

Many studies have suggested that the organization has to establish zero tolerance policy and legislation to reduce bullying behaviours in healthcare settings (Ref-John S. Murray, Barbara S. Broome, Workplace bullying in nursing). (Ref- Barbara S. Broome) suggest that education will help nurses to recognize the bullies and bullying behaviours and provide strategies to eliminate bullying, meanwhile, they state that education on bullying should not only be provided in work environment but also be implemented in universities and continuing education program that empower new graduates to identify bullying behaviours. In addition, Hutchinson (2009) states the current approaches to bullying are remedial, corrective, regulatory and restorative. Remedial and corrective strategies are focus on individual aspect, to provide counselling to the victim, to mediate between perpetrator and target, and to educate and modify the perpetrator’s behaviours. Regulatory and restorative strategies are focus on organizational aspect, to provide prohibitive statements about bullying and to make the perpetrator to make amends (Hutchinson 2009). These strategies are more focus on punishing and blaming the perpetrator which has shown ineffectiveness on reduction of bullying. Hutchinson (2009) proposes another strategy named ‘shared responsibility: a restorative approach to bullying’, which will not focus on criticising the perpetrator but make the bullying behaviours at the centre. Ref recommend that two parties and their supporters need to come together to discuss the bullying situation, share the concern, share the solution of what can do to repair the harm and what can be done to prevent bullying behaviours in the future. It is important to learn forgiveness and create a non-blaming and non-judgemental working environment (Hutchinson 2009).

Rationale for plan

The reason to prompt the change management plan is several complaints from anonymous staffs that they feel being bullied by verbal humiliated, given more workload or hidden information from other staffs, which they have expressed their experience like:

‘My preceptor rolled her eyes and looked at me like I was stupid every time I asked her a question. I finally stopped asking. Doesn’t she realize I’ve only been a nurse for 3 weeks?’ (Ref- Terri Townsend)

‘Our new manager didn’t like me from the start. Within a month, she was assigning me more and more extra tasks until I couldn’t get them all done. When I tried to talk to her about my workload, she said I should be able to handle it because I was the one with the master’s degree. Later she fired me, stating I didn’t meet our department’s expectations, even though I had several complimentary letters from patients and other managers.’ (Ref- Terri Townsend)

In addition, in those complaints, some have mentioned that they don’t feel comfortable to work with certain people, thus, they called sick leave, which has alerted the management that the level of care has been decreased due to patients dissatisfaction and shortage of nursing staffs in the ward that cannot provide effective nursing care. The nursing co-ordinator from the ward has stated that she has to call more agency nurses to replace the regular staffs, whereas, this ward has almost reached the agency budget.

If nurse has resigned from the facility as a result of bullying, this may cause financial burden to the organization. The organization has to pay for recruitment, training sections and orientation for new nurses, which leads approximately $15,000 directly extra cost per nurse (Ref- Reiter).

Therefore, the rationale for the change management plan would be decrease the incident of bullying, increase bedside nurses retention and increase job satisfaction, which may indirect to improve customer satisfaction as a result of increased level nursing care, decrease financial burden to the facility and build up a better reputation for this facility in the industry.

Change Management Plan

The change management plan will be guided by Lewin’s change management model, which includes three phrases: unfreeze, change and refreeze.

Unfreeze

Identification of what has to be changed needs to be determining in this phrase (Ref- Mind Tools). As the anonymous complaints have come to my attention, these complaints will be considered as feedbacks regarding bullying behaviours in this organization. An initial survey will be conducted throughout the facility to address staffs’ awareness of bullying and if they willing to make a change in the work environment. A second anonymous survey will also be conducted to gather personal experiences and attitudes from bedside nurses about work related bullying and how they deal with the bullying behaviours. The surveys allow the management to understand the current perception and interaction of bullying within this organization and also motivate staff to be involved in this changing process.

Another key to change is to make the organization to implement the plan, which means we have to motivate the organization to accept the idea of change is necessary for the facility and support the change (Ref- Mind Tools). The feedback from the staffs has indicated that the bullying behaviours have affected the nurses’ performance in daily nursing care. Bullying has decreased the nursing staffs’ productivity, which leads the quality of care has decreased. Customer satisfaction has decreased as a result form patients cannot receive adequate level of care, in a way that the organization’s reputation would damaged. In addition, the nursing coordinator and the human resource manager expressed that high turnover rate in nursing staff, which has directly made the organization cost extra money for each replacement of nursing position. Therefore, in order to maintain reputation, quality of care and reduce financial burden, the organization has to make a change management plan.

Change

The transition from unfreeze to change will not happen quickly as staffs and the organization has to take time to adapt and accept the new ways of working. In this phrase, people may have questions about the process, such as what is coming and who will be benefit. Clear explanations and honest approach will help dispel rumours (Ref- Mind Tools). As the nursing coordinator and I will explain the coming events , which will include developing zero tolerance policy and legislation, providing education sessions to address workplace bullying and establishing pathway to report bullying behaviours. Staffs may be afraid of being punished because of bullying. Therefore, ‘shared responsibility: a restorative approach to bullying’ from Hutchinson (2009) would be a useful theory to learn. It is also important to inform employees that the plan aims at the behaviours, not to criticise or punish people. The outcome of the change management plan would be create a non blaming nursing culture in this facility, which the nursing staffs will have a nice working environment and prompt them to stay in the profession. The organization will be benefit from the retention of nursing staffs, which reduces costs as a result from nursing turnover.

Empowering the involvement is also important for the changing process. In-services sessions will be held to provide an opportunity for employers and employees to have a face-to-face discussion of identification of bullying and how to deal with bullying, which allow both parties being participate in the process, promote understanding between each party and promote the transition to adapt to the workplace culture smoothly (Ref- Mind Tools). In addition, to establish a pathway of reporting bullying will help the management immediately react to any bulling behaviour that can develop new experiences and attitudes toward dealing with bullying.

Refreeze

In this phrase, the change has adapted to the nursing culture in this facility and we need to develop ways to maintain the effectiveness of change within the facility. For instant, encouraging the nurses unite managers to take the leadership and support their nursing staffs in each ward, frequently collecting feedback from staffs regarding on bullying experiences and running workshops or simulations to keep staffs’ knowledge about bullying is up to date.

Strategies

The aim of auditing is to promote and share best practices in order to provide effective care in daily basis. Developing an auditing is not to criticise poor practices, but by analysing the poor practices will help nurses know and realize what goes wrong and what cloud do better in patient’s care, in a sense that this will prevent the same incident happen again (Ref- Cummins). Therefore, using auditing is the way to assess the outcomes of the change plan. The short term outcomes of audit may show high rate of bullying, the reason would be the nursing staffs are more able to identify the bullying acts in the work environment. However, we would expect that the incident rate would not go up in the long term period.

Feedback from nursing staffs will hopefully provide positive responses regarding to bullying, which can motivate the organization to utilize further education on bullying to improve nursing environment. Survey can also be conducted to collect the objective data, which indicate that how nursers feel the change management plan affects their daily performances.

Conclusion

Bullying is a widespread issue in workplace, in order to make a change management plan that it has to base on evidence support. When innovate a new management, creating the motivation is the first step has to be contemplated, which means the organization accepts the change and the staffs are willing to involve into the new plan. Open and honest approach needs to use to deliver the change as the effective communication can dispel any question or rumour from staffs. Initial supports from the stockholder will empower people to be involved. The consolidation of the change in the current culture involves ongoing support, monitoring and education programs, which increasing the chance of the change becomes norm.

References

Reiter, M., Young, A., & Adamson, C. (2008). Decrease new graduate

nurse orientation costs by using HESI exit exam scores. Journal of

Nursing Administration, 37(10), 459-463.

http://www.mindtools.com/pages/article/newPPM_94.htm

Cummins, F. (2006). Using auditing to enhance and improve practice. Nursing & Residential Care, 8(1), 37-39.