A Matter of Respect and Dignity: Bullying in the Nursing Profession

Laura A. Stokowski, RN, MS

Disclosures

September 30, 2010

In This Article

How Common Is Bullying in Nursing?

Everyone, according to Dellasega, has experienced bullying -- as the bully, the victim, or the bystander. "We have all watched this happen to someone.[4]"

When nurses were surveyed about their personal history with respect to bullying, such as being the target of bullying themselves or witnessing an episode of bullying involving another nurse, the proportion of nurses who had acknowledged this experience varied from about 21% to 46%.[7,14,17,18,19] Stanley and colleagues found that 65% of surveyed nurses had witnessed 1 or more episodes of lateral violence between coworkers.[19] This is perhaps to be expected, given the wide variation and subjectivity in individual definition and perception of bullying.

What Are the Effects of Bullying?

Consequences to individuals. In its victims, bullying engenders distress and emotional pain,[13] anxiety, feelings of isolation, helplessness, and dejection. Psychosomatic symptoms, physical illness, and increased use of sick time are among the consequences of these emotions. Reports of clinical depression and even posttraumatic stress disorder reflect the seriousness of individual reactions to bullying.

Bullying need not be associated with overt anger or aggression to harm its victims. Repeated bullying, moreover, is believed to take a cumulative toll.[16]

It isn't difficult to imagine the effects of bullying on a new graduate nurse who lacks confidence and yearns for acceptance and positive feedback about his or her performance. Bullying at this stage is a cruel indoctrination to the profession and can make students, in particular, feel incompetent, invisible, and inferior.[5]

Whether furtive or flagrant, bullying behaviors are infrequently reported, and therefore infrequently addressed. Fear of retaliation and the stigma associated with being a "snitch" or a "whistle-blower," along with reluctance to stand up to an intimidator, contribute to underreporting.[4,15] Many nurses admit to feeling as though they are in limbo -- unable to cope with verbal abuse, yet unwilling to confront their abusers.[9] Some supervisors will decline to address bullying, even when brought to their attention, or imply that the victim is to blame or that the victim's behavior should change rather than the bully's, essentially shielding the bully from discipline and fostering continued bullying behavior.[20]

Consequences in the workplace. Bullying can create and sustain a toxic work environment.[21] The organizational ramifications of workplace bullying are dangerous and costly. Bullying can erode morale and job satisfaction, leading to loss of productivity, work absence, and nurse attrition.[22] Termination and turnover are expensive sequelae of bullying because most hospitals can ill afford to lose nurses.[13,23]

Bullying is also viewed as a risk to patient safety. Bullying interferes with teamwork, collaboration, and communication, the underpinnings of patient safety. Although to date research linking bullying and patient safety is often focused on disruptive physician behavior,[24,25] the principles are clearly and immediately applicable to other healthcare professionals, including nurses. Intimidation can influence communication in healthcare, and failed communication threatens patient safety.

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