Bullying, Health Care and Me

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It's not just nurses who can be bullies. It's Doctors, PA's, Secretaries, Respiratory Therapists, Managers ... you name it. The health care environment is just teeming with 'em. Throughout my 40 (eek) year  nursing career, I have been witness to and the brunt of bullying. I'm writing this for you. 

A few weeks ago, I attended a lecture, "Understanding and Eliminating Workplace Bullying' given by two nurses from Indiana (Terri Townsend & Pamela Anderson). It made me sad. Bullying interferes with the well-being of our patients, families and of ourselves. Here are some facts that were presented...

Consequences to individuals. 

• Bullying engenders distress and emotional pain, anxiety, feelings of isolation, helplessness, and dejection, physical illness, and increased use of sick time. 

Consequences in the workplace. 

• Bullying can create and sustain a toxic work environment. 
• Bullying can erode morale and job satisfaction, leading to loss of productivity, work absence, and nurse attrition. 
• Bullying is also viewed as a risk to patient safety. Bullying interferes with teamwork, collaboration, and communication, the underpinnings of patient safety.  
• Canada is presently reporting one out of seven adult suicides result from workplace bullying (Workplace Bullying Institute, 2003).

Bullying affects not only the victim; but also the witness (Patten, 2005). The witness begins to wonder if she or he is next. Subsequently, self-esteem decreases, erodes, and gives way to depression and anger for nurses who witness bullying. 

What exactly is Bullying?

• Repeated, offensive, abusive, intimidating or insulting behaviours
• Abuse of power
• Unfair sanctions that make one feel humiliated, vulnerable or threatened.

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As a new nurse in 1976, "bullying" was just part of the deal. An expectation. A rite of passage. I just sucked it up and kept my head down. 

My first bully was my Nurse Manager. She would regularly berate and belittle me, using my peers and patients as her audience. On one occasion she called me out of a patient's room in order to critique my nurses notes. Bombarding me with unrelenting interrogation and petty questions, I started to cry. It just added more fuel to her fire. A doctor stood up and said "Stop!" then asked me to join him in the dictating room so that I could collect myself. I did. And she was furious. I later received a written counsel for 'not supporting management'. I resigned after one year. Upon receipt of my resignation she said, "Oh Joan, I'm sorry you're leaving - you could have been one of 'my girls'".
Ick. No thanks.

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Managers 'Bully' by...

• Public Discipline
• Threatening Consequences
• Playing favorites
• Withholding information
• Setting one up to fail
• Verbal Harassment
• Unfair evaluation

Vessey, 2009,

 The Manager Bully - The main and the foremost purpose of bullying is to hide inadequacy, incompetence and inefficiency. Bullying has nothing to do with managing etc; good managers manage and bad managers’ bully. Management is managing; bullying is not managing. Therefore, anyone who chooses to bully is admitting their inadequacy and incompetency, and the extent to which a person bullies is a measure of their inadequacy.—Himachali

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Ten nursing-years later, improved coping skills were developed including befriending like-minded peers, partying like it was 1989 and 'blowing off' the bullies. In this case it was a very bright ER Nurse who was the Nurse Manager's 'go-to' girl. I was the new kid and she smelled blood. To me, she was consistently angry, flippant and sarcastic. To others, she was intelligent and all-business. Her bullying was directed towards my inexperience in ER Nursing. She would critically assess my nursing care - in front of the patient - and would find fault in anything from the way I might have secured an IV to how I would apply a sterile dressing. All inadequacies were reported to the Nurse Manager as well. I dealt with this by forming close bonds with other nurses and creating a social circle that collegial and fun. I blew her off. It was how I coped. One afternoon, I received a hemorrhaging patient - after working diligently to save this patient, I heard 'Miss Priss' grunting about how shitty my care was, her audience was the Nurse Manager and a couple of his minions. It was then that I spoke up and told my offender to... "Go Fuck yourself". She, in a fit of fury, stormed out of the department and went home. That same afternoon I was counselled for "unprofessional conduct".  It happens.

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The Queen Bee - According to Cheryl Dellasega, a psychologist and professor at Penn State University, Queen Bees are the top of the bullying food chain.  They tend to describe themselves as take charge, having ultra-high expectations of others. They appear on the outside to have it all together. They fail to consider the consequences of their verbal grenades or sabotages. They are really very insecure on the inside, and feel threatened by other women in the workplace.Queen Bees who end up in positions of authority tend to feel they must be in control at all times. They intimidate through belittling, display arrogance and see themselves as being above the rules. They may single out only one individual at a time, making it difficult for their superiors to see what is happening. They have an uncanny knack to look good to their superiors. They also tend to feel very threatened by competent subordinates.

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Twenty nursing-years later my improved self-confidence helped me discover the 'silver-bullet' for dealing with bullies. Simply confront the behaviour. Privately and professionally. Who knew? The days of... "Go Fuck Yourself" had been replaced by "I want you to know that the way to spoke to me a few minutes ago was offensive and disrespectful". That was it. Do it quick. Soon after the event. Then get over it. The bully expects never to be called on their behaviour, especially in an adult manner. They assume you are going to "stir the pot" and gossip about the event. Don't do it. Every bully I have had the opportunity to confront - backed off.

Doctors are tricky. It's tough confronting them. But I encourage you to do it. They are just like everyone else who has a self esteem problem except they have MD behind their names. If a private and professional confrontation doesn't feel comfortable to you, ask for a meeting with your nurse manager, the physician and his/her director. I did this on two occasions and found that communication improved dramatically.

Needless to say, I don't have all the answers. I'm hoping that bullying will be eradicated in the workplace one day but unless we have zero-tolerance to bullying behaviours, I doubt that will be the case. So for now...hang in there and good luck! I hope this helped to shed a little light on such a dark subject.

Have you been bullied? I'd like to hear your story...