Tackling nurse bullying
In a session on bullying among nurses at NADONA's annual conference this week, audience members were invited to say how they felt when a supervisor yelled at them. I heard “embarrassed,” “disparaged,” and “incompetent.”
But one other word stuck with me: “scary.”
Workplace bullying refers to repeated actions directed toward an employee intended to “intimidate, degrade, humiliate, or undermine; or which create a risk to the health or safety of the employee(s).” I was disturbed, but not surprised, by a story told by presenter Debra Hagerty, RN, DNP, CDP, LBSW, NHA, CDONA, FACDONA, an assistant professor at Armstrong Atlantic State College.
She told of a male nursing home administrator who grabbed a nurse by the arm and dragged her down a hallway to “show her what she'd done.” There were consequences, and, of course, it's never appropriate to “lay hands,” as Hagerty said. But it also reminded me of how recently I saw a young man screaming at his girlfriend on a city sidewalk about wanting a sandwich. Gawkers looked on, debating whether to call 911. I asked her if she was okay, the young man invited me to do something physically impossible involving my anatomy, and they quickly got on a bus.
In both of those situations, I doubt it was the first time the offender had shown his true colors. And if either of those situations rings a bell, you have a problem that goes beyond incivility among coworkers
A lot of the problems rife in any facility — the rumor mill, sniping at coworkers, rolling eyes, texting at a meeting — should be addressed promptly by supervisors. But bullying is its own special animal, especially if there are gender dynamics at work.
Having anyone scream at you in a workplace makes you feel awful. But for women, having a male supervisor scream will not only make you feel awful, but likely endangered. Or as a quote attributed to Margaret Atwood says, “Men are afraid that women will laugh at them. Women are afraid that men will kill them.”
This isn't to say a female administrator wouldn't bully a male director of nursing, or that women can't be horrible bosses.
I heard at the conference that some younger nurses have adopted a strategy of being “tougher” through yelling, which is bad for morale, and bad for residents. The expression among nurses of “eating our young,” and the implication of a negative maternal relationship, comes up frequently. But I would posit that gender imbalance is an under-recognized problem in bullying in healthcare environments. Male physicians bullying female nurses is a long-standing issue, but one that I hope is being increasingly seen as unacceptable.
One of the reasons I have that hope is one director of nursing, Yoly Marquez of San Diego, who told the group about a physician who bullied her nurses for years.
“He thought he was God,” she said. She finally pulled him into her office, closed the door and said to him that while he was a good physician with the residents, “I didn't like him as a person and said, ‘You cannot do that to the nurses.'” That empowered other nurses to document their negative interactions with the physician. He recently took another job, much to the relief of staff.
Marquez told me it was difficult to confront the physician, whom she knew wanted the attention.
“He made nurses feel like they don't know anything. He thinks you're a servant,” she said. She had to weigh him as a good referral source with protecting her nurses, and achieved getting the support of her administrator.
That's an important piece of advice for others in a similar position: Both administrators and DONs need to have each other's back in these situations.
Another strategy, discussed by several nurses, is to advise staff that they can say, in a low tone, “Please do not yell at me. I cannot help you when you do that. I am not going to speak to you until you can use a civil tone with me.”
Young employees in particular have to be trained on how to take a deep breath, not cry, and calmly hang up the phone or walk away.
As a DON, it's also helpful to recognize triggers: This can be as complex as workload, or as simple as hunger. Bullying and incivility occur when people are stressed, rushed, overworked, fatigued or hungry, Hagerty noted. Resisting looking for blame, making dialogue safe, saying thank-you and listening are also ways to promote a healthier workplace atmosphere, she says.
Ultimately, it's up to leadership to put their foot down about what is appropriate behavior, for the sake of residents and staff. Remember, as Hagerty says, that bullying “hurts the heart, and it hurts the soul.”
Elizabeth Newman is Senior Editor at McKnight's Long-Term Care News. Follow her @TigerELN.