Maggie Ciocco, MS, RN, BC, is a nursing program advisor for the W. Cary Edwards School of Nursing. She has more than 25 years of experience in nursing education as a preceptor, mentor, staff development instructor, orientation coordinator, nursing lab instructor and clinical instructor. She is the author of Fast Facts for the Medical–Surgical Nurse: Clinical Orientation in a Nutshell and Fast Facts on Combating Nurse Bullying, Incivility and Workplace Violence (Springer Publishing Company), which received a 2017 Book of the Year Award from the American Journal of Nursing. Ciocco was recently chosen by the American Nurses Association (ANA) to serve on its End Nurse Abuse Advisory Committee.

The Silent Acceptance of Bullying in the Nursing Profession

By Maggie Ciocco MS, RN, BC
Nursing Program Advisor, W. Cary Edwards School of Nursing

Would you recognize workplace bullying if you saw it? And, if you recognized the behavior, would you do something about it?

Before you jump to an obvious response, consider the dynamics.

In reality, nursing staff who are being bullied often feel they have no options to report it and their managers often tolerate the behavior in the interest of patient care delivery and their institution’s bottom line. As a consequence, it may come as no surprise to those in the profession that bullies often have a supportive atmosphere in which to continue terrorizing their colleagues.

The offender views theis 'silence' as tacit acceptance and continues their behavior. By extension, if nursing staff observe that leadership is tolerating bullying and uncivil behavior, they feel that there is no one in a leadership role to turn to for help. The bully is often further supported as they move ahead in their careers and assume increasing levels of responsibility. This is compounded if the bully leader is also productive and meets the goals of the facility. Others in leadership roles may not approve of the behavior or even be aware that it is occurring, but staff, and the bully’s peers, understand that silence is complicity.

Several studies have noted that bullying is more pervasive in healthcare facilities where employees feel that a certain level of bullying behavior can be tolerated and that those who bully are often indirectly rewarded – via pay raises and job promotions.

Many nurse leaders and healthcare administrators feel that they are unable to deal with bullying and incivility. Unfortunately, managers may feel that their staff members are merely there to get a job done – their presence or absence affecting patient care and the bottom line. It does not matter to them what is affecting their employees, but only the way that the victim’s behavior may be affecting the unit as a whole. The victim is consequently not viewed as a person with rights. The cycle is perpetuated as others who are bullied remain silent.

Organizations are learning that professional training can help managers better identify, acknowledge and eliminate bullying behavior. Constant monitoring of bullying or incivility by those in leadership can occur and appropriate actions taken to neutralize the behavior. Policy and procedure intervention is also appropriate when a bullying incident is identified.

When monitoring for bullying behavior among staff, nurse leaders should be aware of:

• Nonverbal behaviors in response to comments from a bullying victim


• Failure to respect the privacy of another nurse
  


• Complaining about another nurse behind his or her back
  


• Betraying confidences


• Not taking responsibility for actions and blaming others in a bad situation


• The existence of cliques that exclude others
  


• Infighting among the staff


• One nurse setting up another nurse for failure


• Withholding patient care information


• Snide or rude remarks or abrupt answers to questions among staff or team members

The key to stopping nurse-to-nurse bullying is to be aware of what causes the behavior in the first place, knowing who is vulnerable and preventing future episodes. What’s more, the staff who are experiencing the bullying behavior should not assume that those in leadership are aware that the problem exists or assume that the behavior has already been reported but never acted upon. In the next issue of Signals I will address steps nurse managers and staff can take to prevent bullying behavior. If you would like to discuss the issue of nurse-to-nurse bullying and ways you feel it can be combatted, we’d like to hear from you. Email us: nursing@tesu.edu. Please indicate Bullying in the Nursing Profession in your subject line.

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