Bullying: The Under-Reported Threat in the Healthcare System
Bullying is a common behavior that is under-reported in the healthcare system. The system that we hope is made up of caring and compassionate healthcare workers may be filled with hostility and sabotage. The results are poor patient care, high absenteeism, and high staff turnover.
Workplace issues related to bullying occur in different forms. The simple actions of purposeful lack of cooperation between staff, missing deadlines, turning in late paperwork, and withholding information about patient care from peers are considered bullying. More extreme examples are public reprimands, insults, spreading rumors, and condescending behaviors.
According to the Joint Commission on Aging (1), the most common healthcare settings where bullying is prevalent are behavioral health units, hospital emergency departments, and intensive care units. In nursing homes bullying more frequently occurs during evenings and overnight. Case management departments in hospitals are other common settings for bullying.
Bullying behaviors translate to inappropriate behaviors with older adults and their caregivers. Pressures to discharge older adults from hospital emergency rooms and skilled nursing facilities are transferred to the family.
Bullying has been prevalent for so long that nurses report being used to poor treatment. As a result, no reports are made to management about inappropriate behaviors. Nurses, accepting bullying behavior as normal, bully each other.
Why Bullying Occurs
Healthcare positions are stressful. Healthcare workers respond daily to changes in health, emergency situations, difficult family members, and sometimes the death of patients and residents. Regulations in the healthcare system are challenging. Staff juggle the care of multiple patients and respond to tight deadlines.
Combine workplace stress with the personal problems of healthcare workers and the setting is like a ticking bomb. A single bully spreading venom, and anxiety, and inciting stress across an entire team destroys a productive work shift. Employees become so emotionally distracted that they are unable to focus on work.
Like the saying, one bad apple spoils the bunch, one caustic physician or a demanding nurse interferes with team morale. The result is poor patient care and errors. A report by Health Trust (2) confirms the risks.
“If you’re not happy at work, you’re not going to do the best you can do. If you’re refusing to be a collaborative team member, somebody else is going to have to do that work alone. Then you risk injury to the patient as well as your coworker. It casts a horrible cloud over the entire department.”
Supporting Collaboration and Ethical Behavior
Management in all healthcare settings is responsible for condoning this bad behavior. Ongoing discussions reviewing ethical behavior and good character are part of the solution. Another solution is frequent management and supervisory contact with employees that includes reporting of bad behaviors.
Employee training to support responses to crisis situations has been implemented in some healthcare settings. In some cases, crisis situation training applies to responding calmly to bullying situations. Situations have been reported where peers purposely ignore requests for assistance by teammates, resulting in injury to a co-worker or a patient.
Bullying is more problematic when management is identified as part of the problem. Employees are fearful of speaking up to management for the risk of losing their positions. Other employees have frequent absences or quit because they do not want to be continually exposed to caustic and threatening behaviors.
Health Trust (2) reports verbal harassment between nurses as the most significant at 45%, followed by harassment by management at 41%, and by physicians at 38%. Leadership must take a firm stand to reinforce collaborative workplace situations. Allowing the behavior by doing nothing supports more of the bad behavior.
Collaboration Across Disciplines
In the healthcare industry, patients are transferred from one setting to another to receive care and treatment. For example, an older adult may transfer from home to hospital for treatment, and return home. Older adults may be transferred from assisted living community to the hospital for treatment, than to skilled nursing for rehabilitation, and eventually returned to assisted living. Each transfer requires positive and timely collaboration that I confirm from my experience does not always occur.
Collaboration Purposely Made Difficult
Collaboration across disciplines is made more difficult when caustic environments exist. An example is a scheduled assessment for an individual living in a skilled nursing community who wishes to move to assisted living. For this transition, an in-person assessment and review of medical records must occur by the assisted living staff.
Upon arrival at the nursing home, the assisted living community staff met with the client. Next, seeking out medical records, the nursing and social service staff refused to release records. The report from the staff was that the director of nursing did not relay information about the assessment to approve the release of the information.
It was confirmed that emails and phone calls were made to the director of nursing who purposely refused to cooperate. Inappropriate obstruction of information occurs by individuals in power who want to exert control over staff in lower positions and make transitions more difficult.
Other common issues in collaborating across disciplines are purposeful delays in providing timely information to meet deadlines, failing to provide the correct forms for signature, and information becoming lost in multiple fax transmissions. When community staff is divided, collaboration with providers outside of the community becomes painstakingly difficult. Older adults and caregivers are caught in the middle of these battles.
This unprofessional conduct infects entire organizations and becomes the norm. Unprofessional behavior is a violation of professional ethics policies.
Caring staff will leave the workplace to avoid daily battles with poisoned peers. In these situations, the only solution may be a total staff performance review and clean-out of problematic employees.
Positive Cultures Result in Positive Workplaces
When management is supportive of a positive work environment, ongoing discussions occur in the workplace about what companies are for and against. For example, we are for teamwork and collaboration. We are for a positive work environment. We all work hard and help others when needed. No complaining. No whining. No excuses.
We are against gossip, dishonesty, and talking negatively about teammates. We are against not doing your job and expecting others to pull your weight. Warnings occur to potential employees that if behaviors occur that fall into the negative or bullying category termination will be immediate. There are no second chances. Rotten apples don’t apply or will not last in this company culture.
When a positive work environment is consistently embraced, employees begin verbalizing for and against beliefs. They call out peers who are behaving inappropriately. They become more confident in their abilities and self-esteem rises. Performance goals are more easily achieved because employees work together as a team.
The work environment becomes more positive. Patient care improves. Patient satisfaction increases. Collaboration occurs across disciplines because staff behaves in a positive and welcoming manner.
While turnover and replacing employees is time-consuming and expensive, allowing bullies in the workplace creates chaos and permanent damage. Morale is poor. Client care is compromised. Negative attitudes prevail. Management who supports this type of negative environment must change direction or be terminated.
Patients place their lives in the hands of healthcare providers. Life is too precious to be damaged by a manager who allows employee bullies to destroy teams and company morale. It’s time for leadership to take a stand. It’s time to reinforce collaboration.
(1) The Joint Commission, Division of Health Care Improvement, “Quick Safety: Bullying Has No Place in Healthcare,” Issue 24, June 2016.
(2) Health Trust, “Taking a Stand Against Bullying,” Retrieved 10/22/18 https://healthtrustpg.com/professional-development/taking-stand-bullying/
© 2018 Pamela D. Wilson, All Rights Reserved.