July - Saint Clare's Hospital

VOLUME 3 ISSUE 4
NDNQI
This October, Saint
Clare’s Health System
will again participate in
the National Database
of Nursing Quality Indicators
RN Survey. The survey is offered to direct care RNs in member
hospitals. According to the NDNQI, in 2011 over 325,000 RNs
from 893 hospitals responded to the survey. The purpose of the survey
is to obtain a picture of the RN work climate on every participating
unit in Saint Clare’s. This year, the Maternal Child units will
participate for the first time and Saint Clare’s will utilize the long form.
Confidentiality is protected and reported information is summarized
for the entire hospital as a whole and individual units. Details will
emerge as the October start date gets closer.
Marianne DeAlessi, BSN, MPA, RN, CSN-NJ
Director of Nursing, RRC
UNDERSTANDING BULLYING IN THE
WORKPLACE: PART 2, THE EFFECT ON
THE NURSING TEAM
In Part 1, what is bullying? a definition of bullying/workplace violence
and five types of bullying were discussed. To review, bullying is
consistent, repeated, offensive behavior that undermines employees
and creates a stressful work environment for the victim and the other
employees (Beers, 2012). Bullying can be both covert, subtle rude behaviors
and innuendos, or overt, openly abusive, physical or psychological
(Lesley, 2006). The five categories of bullying include: 1) threat
to professional status, 2) threat to personal standing, 3) isolation, 4)
overwork, and 5) destabilization (Rayner & Hoel, 1997). The challenge
to the reader at the end of Part 1 was to observe the personal
work environment to identify any bullying behaviors that may fit into
one of the five categories. Nurses often tolerate bullying as part of the
job and unless nurse leaders provide training, nursing staff may not
identify the behaviors toward them as bullying. Identification of bullying
is necessary to prevent deterioration of the nursing team, which
promotes a safe patient care environment.
The effects of bullying on the nursing team result in decreased
motivation, decreased morale, decreased productivity, increased error
rates, increased turnover, and increased stress (Martin, Gray & Adam,
2008; Yildirum, 2009). Verbal abuse is the most common but least addressed
behavior on the nursing unit. The verbal abuse behaviors of
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the bully include aggressive communication behavior, sarcasm, insults,
and refusal to support the nursing team. On nursing units, the staff
sometimes creates work-a-rounds to reduce interaction with a bully.
An example of subordinate to manager vertical workplace violence
is when a unit secretary is rude or sarcastic toward the charge
nurse. The nurse may ask the unit secretary to place a call to a physician
and the unit secretary responds with undertones, nasty facial expressions,
or does not make the call. The charge nurse is intimidated
and may create a work-a-round such as asking a nursing assistant to
perform the task, or doing the task herself so that she does not have
to interact with the bully. All of the nursing team members, including
the manager, are probably aware of the situation and bullying behaviors,
but no action is taken to address the behavior. The result is a
devalued feeling among the rest of the nursing team. One concern is
that if an emergency occurs on the nursing unit, and the unit secretary
is scheduled to leave the unit for a break, the deflated charge nurse
may not confront the bully and ask her to take her break at a later
time. The message the nurse leader is sending to the staff is that the
bullying behavior is acceptable, which further demoralizes the staff
and creates a stressful environment.
Verbal abuse by power and status occurs between a physician and
a nurse or a patient and a nurse. The literature documents several studies
where nurses fall prey to the verbal abuse of physicians. Physicians
may scold, demean, or behave in an intimidating manner to nurses in
public areas and in front of patients. Physician intimidation may result
in delays in patient care because nurses may become afraid to call
with abnormal blood values or change in status. A novice nurse may
be intimidated to the point that she is unable to critically think in an
emergent situation in the presence of a physician who is intimidating
(Berry, Gillespie, Gates, & Schafer, 2011). Patients may be verbally
and at times, physically abusive to nursing team members citing the
Patient Bill of Rights as a license to be abusive.
The patient is a passive victim of bullying behaviors for several
reasons. Morale is low on the unit which results is decreased team
work that causes delays to patient call bell requests and may result in
care delays if a nurse or nursing assistant is tied up with a patient and
can’t attend to other patients or round hourly. A positive correlation
between nursing staff illness and bullying results in increased sick calls
and turnover rates, which in turn may result in short staffing and increased
agency nurse usage (Berry, Gillespie, Gates, & Schafer, 2011).
Bullying behaviors of seasoned nursing staff impedes the ability of the
novice nurse to focus on critical thinking skills, and cope in complex
situations. The delay in gaining competency skills results in decreased
(continued)