As incidences of violence against caregivers continue to rise, workplace safety for healthcare professionals has become a widespread concern. But one aspect of workplace safety that's too often overlooked is culture. When the culture of an organization allows behavior like rudeness and outright bullying to exist, the environment is more conducive to violence. Although bullying within the workforce and violence directed at employees from patients may seem unrelated, both are a culture problem requiring direct and swift action to resolve.
Incivility and bullying in healthcare
The American Nurses Association (ANA) notes that, through examining the various forms of incivility and bullying that tend to occur in the workplace, nurses (and, in turn, all healthcare workers) can collectively create a better culture. In other words, it’s as important to call out incivility and bullying as it is to stop violence from occurring.
Incivility is most often defined as rude or offensive comments or behavior. And it’s so common that healthcare workers might not even realize it’s a problem. For example, gossip is a form of incivility, as is refusing to assist a coworker. Speaking in a condescending tone and publicly criticizing someone are other types of incivility that occur with alarming frequency.
Bullying is yet another. The ANA defines bullying as “repeated, unwanted harmful actions intended to humiliate, offend, and cause distress in the recipient.” Bullying is a serious and all-too-prevelant concern today, and we must address bullying in the workplace for the safety and well-being of healthcare employees.
The healthcare safety repercussions of bullying
Unfortunately, healthcare leaders themselves can be bullies. They may ridicule or criticize staff members rather than coaching staff to support their professional growth. Or they exclude employees who think, look, or believe differently. There are many reasons to eradicate bullying from the healthcare workplace—including its impact on safety. The AMA Journal of Ethics describes this scenario: A surgeon yells at a resident in front of their colleagues. As a result, that resident is hesitant to bring up a potential patient safety issue. It’s a no-win situation. A culture where fear, insults, and bullying prevail has far-reaching implications across an entire organization.
Additionally, there’s evidence that incidences of violence rise when a facility is short-staffed. Patients are more frustrated, and staff members are more prone to mistakes. When a culture permits bullying, employees are more prone to leave the organization too: No one wants to feel disrespected at work. And nobody should have to.
A zero tolerance policy for bullying requires strong leadership
Press Ganey’s workforce consultants get to see how many different kinds of healthcare teams function, and we sometimes encounter bullies who are in positions of authority. In one situation, two nurses, who worked together on the night shift for many years, had developed a pattern of bullying and harmful behavior toward other staff members, particularly those new to the unit and shift. As a result, the facility had high turnover on the night shift.
A new nurse manager assessed the situation in an effort to figure out why turnover was so high for that particular shift. She identified the issue, implemented a “no-bullying” policy, and transitioned the two nurses out of their roles. Turnover quickly decreased as a result.
We’ve heard bullies described as just “a little rough around the edges” or even “great as a clinician.” Yet, no matter how brilliant or talented someone is, bullying is, across the board, unacceptable—not to mention that regular turnover among the rest of the staff is unsustainable.
Instituting a no-bullying policy requires strong leadership—leaders who aren’t afraid to hold people accountable and enforce consequences for poor behavior. Without senior leadership on board, changing the culture of an organization often fails to launch.
Creating a culture that values workplace safety is well worth the effort. A culture where people feel safe improves retention and perceptions of quality of care by healthcare teams—which, in turn, improve safety outcomes.
Press Ganey’s strategic consulting team partners with top healthcare organizations to drive the employee experience and workforce improvements. Get in touch with our strategic consulting experts to discuss your organization’s culture, and learn how to better educate, train, and connect with employees, at all levels, to put an end to incivility and bullying in healthcare.