This research examines instances of bullying, incivility, and violence among nurses, nursing students, and patients. According to studies, bullying, incivility, and violence occur not only in the clinical context, but also in home health nursing, the academic environment, and the outpatient setting. Bullies in the nursing profession include ""the super nurse, the resentful nurse, the put-down nurse, gossip and rumors nurse, backstabbing nurse, green-with-envy nurse, and cliquish nurse"" (Thobaben, 2011). The previously stated nurse groups engage in activities that have a negative impact on health-care operations. "Nurses of all ages can be affected by bullying, so empowering initiatives need to be developed to prevent perpetuation and victimization" (Longo, 2013). This research article also identifies the indicators and effects of bullying, incivility, and violence, as well as roles of the involved organizations, prevalence, and prevention.
Keywords: bullying, incivility, violence, nursing
Bullying, Incivility and Violence
Introduction
Bullying is one of the significant challenges that nurses encounter in their daily operations thus the need to initiate practical ways of enhancing the safety of the healthcare providers. Scholars define bullying as reported and consistent unreasonable actions against a worker or group of workers with the aim of causing harm either psychologically or physically to the target. Apart from bullying, horizontal violence (whereby nurses humiliate their colleagues either physically or emotionally through the use of demeaning words) and incivility are also prevalent amongst the nurses. Studies show that various organizations have initiated multiple ways to curb incivility, lateral violence, and bullying in the healthcare organizations and learning institutions.
Indicators of Bullying
Scholars argue that horizontal violence, which is repeated-physical actions, aggressive or hostile behaviors are also prevalent amongst the registered nurses operating in different organizations. According to Thobaben (2011), bullying and violence take various forms, some of which are subtle while others are blatant. One of the significant indicators of bullying is physical threats or intimidation. Indeed, a majority of the bullies threaten the nursing students or the registered nurses when they feel that the victims are not performing their activities correctly. Precisely, the perpetrators of violence, shove, hit or throw objects at the victims as a way of expressing their displeasure.
Scholars also attribute verbal or written innuendos such as gossiping and sharing confidences about a colleague to the incivility in the health sector. In essence, some of the nurse professionals share the information about their colleagues without considering the psychological harm which they cause others. Sarcastic remarks or statements that belittle other nurses are critical indicators of incivility amongst the nurse professionals and the comments adversely affect the relationships between the healthcare practitioners in a given setting (Meierdierks, 2015). Also, nurses experience incivility through inappropriate body languages from the patients or colleagues in the senior ranks. For example, the bullies toss their eyes, rolls their heads or provide exasperated sighs in a manner that significantly portrays lack of respect to the targets. Thobaben (2011) argues that sexual harassment is also an indicator of violence in the nursing sector, whereby the bullies use gender or sexual-related slurs against their coworkers or nursing students thereby causing great harm to the emotional welfare of the victims. The final indicator of bullying and incivility in the nursing profession is poor relationships between the administrators and the clinicians (Meierdierks, 2015). Precisely, the decision by the administrators to assign unrealistic tasks, belittling of the nurse's concerns and invalid criticism are significant indicators of the prevalent bullying or incivility in the health sector.
Roles of Organization
Professional organizations have established various policies that guide the operations of the nurses. Specifically, the nurse administrators such as American Nurses Association (ASA) and the State Board of Nursing have established codes that guide the relationships between the nurses and their colleagues, and between the nurses and patients. Precisely, the section 1.5 of the ANA's code of ethics for nurses with interpretive standards states that nurses need to display compassionate relationships with their colleagues and the public to help in the enhancement of integrity and provision of quality services to the patients (Flateau-Lux & Gravel, 2013). Also, the organization above emphasizes that nurses need to amicably solve their differences and ensure that there is a favorable environment for the execution of nursing activities. However, an analysis of the current events in the health sector indicates that professionals have failed to implement the codes of ethics that are necessary for the reduction of bullying and incivility in the hospitals and medical colleges.
Scholars argue that the emotional and psychological challenges that the nursing professionals and students experience in their early years in the nursing profession or during the training process adversely reduce their service delivery by making them prone to erring while treating patients. According to Flateau-Lux and Gravel (2013), the frustration that nurses undergo due to incivility also adversely affect nurse retention thereby making hospitals to be understaffed. Moreover, patients suffer when nurses experience various forms of bullying. Therefore, a Joint Commission on nursing practices recommended a set of leadership strategies for ensuring that leaders efficiently resolved conflicts in the health sector (Flateau-Lux & Gravel, 2013). The Center for American Nurses has also played a critical role in highlighting the need for healthcare organizations and professionals to eliminate incivility and violence in the hospitals and medical training institutions (Meierdierks, 2015). Therefore, from the strategies that various groups have established, it is evident that the society aims at improving the welfare of the nurses and nursing students.
Prevalence
Students
Scholars have discovered that apart from the professional nurses, nursing students also undergo various forms of bullying from some of the older nurses. A study that McAdam-Cooper conducted in the US indicated that 95.67% of the nursing students had experienced the kinds of bullying such as rude behaviors and exclusion among others (Meierdierks, 2015). Also, the study by McAdam-Cooper and others identified nursing instructors as the principal source (30.2%) of bullying that the nursing students suffer while classmates and patients contribute to 15% and 14% of the humiliations that practitioners undergo (Meierdierks,2015). Similarly, a study that Stevenson and his colleagues conducted in the United Kingdom showed that 53% of the students had suffered bullying from the physicians and senior nurses, 34% underwent exclusion while 30% and 29% faced destructive criticisms and humiliation in the presence of other learners (Flateau-Lux & Gravel, 2013). Some nursing students start experiencing bullying while they are still in their third years in the medical colleges and the trend continues up to the time when they secure employment.
Nurses
An analysis of the activities that occur in the health sector indicates that cases of bullying in the nursing profession are also prevalent among the workers who have taken less than five years in the service (Longo, 2013). However, some of the nurses who have been in the profession for a long time also experience other forms of disruptive behaviors from their juniors who think that they have higher academic qualifications compared to the older nurses. In most cases, the nurses who have been in the nursing profession suffer disruptive behaviors from the colleagues who are envious or practice exclusion as a way of humiliating the colleagues they perceive as adversaries. Thobaben (2011) opines that bullying in the nursing profession is prevalent because nurses lack autonomy, accountability, and control over their job and feel that they are inferior. Consequently, nurses behave aggressively against their coworkers as a way of relieving tension. Also, bullying in the nursing sector develops when the victim holds a junior position in an organization or comes from a minority group in the society.
Patients
Patients are also perpetrators of some of the forms of bullying that nurses and nursing students encounter. Specifically, according to Meierdierks (2015), homes and patients contribute 64.7% of the cases of harassment that nursing students undergo. However, studies indicate that some victims of incivility do not report the problems that they endure. The failure by the victims of bullying to communicate the challenges that they experience due to misbehaviors from the patients is also a significant contributor to the increase in the violence in the nursing profession. Patients are also victims of violent behaviors that results due to the frustrations which nurses endure in the course of their operations.
Prevention
The critical step in controlling bullying in the health sector is the acceptance that nurses undergo various forms of violence that critically impedes their productivity. Indeed, the acknowledgment of the problems of incivility among the health professionals will aid in the development and implementation of various strategies to improve the welfare of victims of bullying. Thobaben (2011) opines that hospital administrators can eradicate the problem of bullying by establishing stringent disciplinary actions against the perpetrators of violence among the nurse. For instance, the termination, suspension, and reporting of the cases of harassment and incivility to the regulatory authorities will significantly help in promoting morality in the health sector. Also, it is necessary for the leaders to establish effective strategies that allow the victims of incivility to report the misbehaviors that they undergo to the civil authorities such as the police to enable proper investigations and appropriate actions against the culprits (Meierdierks, 2015). Indeed, the existence of viable channels for reporting the challenges that one undergoes will efficiently motivate the victims of violence and deter the perpetrators from continuing the heinous acts.
As a way of preventing the prevalence of incivility among the nurse professionals and the nursing students, it is also vital that administrators change the culture in the health sector. According to Meierdierks (2015), a majority of the perpetrators of bullying and violence engage in the heinous act because they perceive the activity as a norm in the health sector. For instance, the perpetrators had at one time become victims of incivility hence continue the practice to retaliate against the recruits or the nursing students. Consequently, it is necessary to change the culture of bullying through education. Specifically, the administrators of medical colleges need to modify the training that students receive in a way that castigates horizontal violence in the health organizations. The sensitization on strategies for eradicating violence against the nurses is also necessary for the hospitals whereby leaders convene staff meetings and seminars through which they provide the workers with conflict management skills (Meierdierks, 2015). Finally, nurse administrators can efficiently change the culture of bullying in the nursing profession by developing a unit whose primary role is to enforce the policies concerning the eradication of incivility in the hospitals.
Conclusion
As discussed in this essay, incivility, bullying, and violence are prevalent amongst the nurses and the nursing students thus adversely affect the operations of the health organizations. The indicators of the heinous acts above include shoving, exasperated sighs, gossiping, gender slurs and allocation of unrealistic tasks, among others. Therefore, it is essential for the organizations to establish stringent policies and educate the nurse professionals to help alleviate the challenges that clinicians undergo in the course of their daily operations. Finally, empowering nurses will also aid in curbing the cases of incivility and lateral violence among the clinicians.
References
Flateau-Lux, L. R., and Gravel, T. (2013). Put a stop to bullying new nurses. Nursing, 43(6), 24-28.doi: 10.1097/01.NURSE.0000429803.49353.c8
Longo, J. (2013). Bullying and the older nurse. Journal of Nursing Management, 21(7), 950-955. doi:10.1111/jonm.12173
Meierdierks Bowllan, N. (2015). Nursing Students' Experience of Bullying. Nurse Educator, 40(4), 194-198. doi:10.1097/NNE.0000000000000146
Thobaben, M. (2011). Bullying in the nursing profession. Home Health Care Management & Practice, 23(6), 477-479. doi:10.1177/1084822311413556
