According to the National Institute for Occupational Safety and Health (NIOSH), there are four types of violence that nurses might face in their work environment:
- Criminal Intent: The offender has no relationship with the victim, and the violence occurs alongside a crime. For example, a nurse might be assaulted in the hospital parking garage, or a home health care nurse might be mugged while making a home visit.
- Customer/Client: This is the most common type of assault in healthcare environments. The offender is usually a member of the public with whom the nurse interacts during regular duties. Research shows this type of violence frequently occurs in emergency and psychiatric treatment settings, waiting rooms, and geriatric settings, but it can happen anywhere.
- Personal Relationship: The victim is targeted due to an existing relationship with the perpetrator, with the violence occurring in the workplace. For example, a nurse’s spouse may follow her to work, threaten her, and create a dangerous situation for her, her coworkers, and patients.
- Worker-on-Worker: Often perceived as bullying, this involves coworkers and can range from verbal and emotional abuse to homicide. This form of violence, known as lateral or horizontal violence, frequently manifests as unfair, offensive, vindictive, or humiliating behavior. It often involves supervisors targeting subordinates or peers targeting each other, including nurse-to-nurse incidents.
In this blog post, I will focus on worker-on-worker violence, which has a particularly damaging impact on team cohesion and patient outcomes. The American Nurses Association defines nurse bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient,” noting it as “a very serious issue that threatens patient safety, nurse safety, and the nursing profession as a whole.” These incidents severely affect the psychological well-being of the targeted nurse and their ability to care for patients. Additionally, bullying creates a toxic work environment, fosters burnout, affects retention, and impedes patient care—a lose-lose-lose situation.
Nurse managers, chief nursing officers, and hospital administrators cannot allow bullying to fester in your institution. If you do, you are simply not fit to lead. Addressing incivility or bullying requires a two-pronged approach: one from the nurse’s perspective and another from institutional leadership. This post covers the nursing perspective.
Addressing bullying from the nurse’s perspective involves a triple “R” approach: Recognition, Resilience, and Resistance.
- Recognition: Understand that bullying is a reality. A Nursing Administration Quarterly article by Edmonson and Zelonka (2019) reported that “nurse bullying occurs in almost all care settings and units, from the patient floor to the executive suite.” In one 2018 study, 60% of nurse managers, directors, and executives reported experiencing workplace bullying, with 26% considering it severe. To address this form of incivility, we must recognize that it is a sad reality in nursing.
- Resilience: Resilience is the capacity to withstand or quickly recover from difficulties. Protect yourself psychologically while addressing these unfortunate circumstances, believing there may be growth opportunities for the victim, rehabilitation for the offender, and cultural improvement. To be clear, there is no excuse for being a bully; it is a detestable act. However, when the victim stands firm, there might be redemption – even for the offender.
- Resistance: Resistance is the refusal to accept or comply with something—in this case, bullying. One must be brave enough to have had to say, “Time out. Enough is enough!” Bullies are often mentally weak individuals masquerading as tough. Bullying often reflects an underlying psychological problem. Stand up firmly, and they will back down. It is not easy, but it is necessary, and fostering an anti-bullying culture is crucial.
By recognizing bullying, building resilience, and resisting unacceptable behavior, nurses can protect themselves and their colleagues, ultimately improving the work environment and patient care.