Managing the Sound of Silence
The phenomenon of bullying in nursing is not new. Yet despite policies of zero tolerance, bullying continues as an “organizational undiscussable” (Beer & Eisenstat, 2000) that incubates and proliferates in a culture of silence. Dealing with a workplace bully who is a nurse presents the nurse manager with time-consuming and extraordinary personal and professional challenges. This chapter focuses less on the troubling characteristics of bullies and more on what to do about them. The intent is to encourage you to take the necessary steps to fuel and support your resolve to rid your workplace of bullying behaviors.
In this chapter, you will learn:
1. Bullying is preventable
2. Your vital role in eliminating bullying from the practice setting
3. Skills and processes for managing bullying
THE BEGINNING OF THE END OF WORKPLACE BULLYING IN NURSING
In the 1990s, bullying in the workplace was acknowledged through the introduction of Zero Tolerance policies in many organizations. Although its presence was acknowledged with the introduction of these policies, it was rarely talked about openly. Nurse managers and staff remain reluctant or unsure as to how to characterize or manage this behavior. Many managers who attempt to deal with this issue continue to struggle to receive organizational support, and the process intensifies when the union becomes involved. The presence of a bully is still tolerated in silence, and victimized staff members continue to leave “to further advance” their careers. Remaining staff tiptoe around the bully, excusing his or her actions with, “You get used to it,” or “They don’t really mean anything by it. She (or he) is a really good nurse.” Even with the assistance of the evolving and enlightened support of human resource staff, bullying continues to flourish. The fact that bullying is still prevalent speaks to the issue that current strategies are not working.
Nurses continue to turn on one another, especially during significant organizational change and deteriorating workplace conditions that evoke feelings of powerlessness, fear of the unknown, and frustration. As daunting as it may seem, nurse managers have the greatest ability to end bullying in clinical practice settings.
MONKEY IN THE MIDDLE
In unionized environments, nurse managers can be set up for a “monkey in the middle” situation. They become caught between the perpetually warring factions of union and management, where what began as an issue of negative behavior of a staff member becomes an attack on the manager’s credibility.
ARE YOU UP FOR THE CHALLENGE?
Before dealing with a bully, many nurse managers will quietly ask themselves if they are “up for this.” Some believe that they may be “hung out to dry” and will search their souls asking if sacrificing their mental health is too high a price to pay. Some may ask if the situation is really all that bad. Others may suppose that if they did not witness the behavior, they cannot do anything about it. A few may even excuse the behavior or justify it by noting, “Well, that’s just the way they are.” The cost of inaction is high, and patients and staff will pay the price. Staff will lose respect for their manager, thinking (sometimes rightfully so) that nothing is being done. They will continue to live and work in a state of fear, and deep inside you will know that you are not doing the right thing. In the end, good staff will be left to manage a struggle that should not be theirs in the first place, and the bully will retain the seat of power above all.
Patient care suffers chiefly due to failure of effective communication between the victim and the bully borne from the fear of criticism or ridicule by the bully, or both. This situation can lead to oversight in care or unreported clinical information, and becomes a practice issue that violates standards of practice standards.
WHY BULLIES THRIVE
Despite our knowing a great deal about workplace bullies—what makes them tick, their impact on victims, peers and quality of care, and costs to the organization—bullying continues. Why? Because it can! It remains grossly underreported and unmanaged and rarely is brought to the attention of the professional regulatory body. Bullies thrive on silence. We tolerate bullying behavior because of:
• Fear: Bullies are scary! Many nurse managers are afraid of bullies.
• Denial: Managers may deny the existence of a bully in their workplace.
• Organizational nonsupport: There may be a lack of meaningful policies or support for nurse managers.
• Exhaustion: Managers may lack the stamina or time to go down that long and winding road of performance management.
• Escalation: There may be a (legitimate) concern that the behavior will escalate into physical violence, at or outside of work.
• Unwillingness to take on the union: The possibility of an adversarial encounter with the union or litigious actions by the staff member is not something most managers want to take on.
• Costs: Managers may be reluctant to hop on the medical leave of absence merry-go-round, which occurs when the bully, realizing the toxic behavior is no longer acceptable, takes medically approved sick leave, comes back, goes off again, and returns ad infinitum—sometimes for years!
• Workload: Managers may dread the consequences of adding more difficult work to their already heavy workload.
• Credibility: Managers may worry that the tables will be turned and he or she will be seen as the real problem.
• Reluctance: Even with support it is something most organizations do not want to tackle.