2020 -Year of the Nurse - And a Disturbing Trend in Bullying
Would you believe that the tumultuous 2020 was declared the Year of the Nurse and Midwife by the World Health Organization? There's no question that health care workers have stepped up and given selflessly during a frightening time for Canadians and the world.
However, it feels a little ironic to note that during what many consider a disaster year overall, nurses are under more pressure, more stress, and workplace violence on top of it all. Plenty are looking for new positions and even career changes. Many are burned out.
These are unique times in nursing; pressure and abuse from management and bullying among colleagues have been reported. Sometimes the anecdotal horror stories are shared privately and anonymously, while in other cases, studies have been done around the world to shine a light on nurse bullying.
Nurses are taking hits from all sides, and it's not acceptable.
Whether a new nurse or a seasoned expert, bullying, interpersonal toxicity, lack of support, or pressure from management can be enough to drive someone out of their job. In fact, these phenomena sucked the joy out of nursing for some long before the COVID-19 pandemic hit.
But now, some nurses are sharing their fears for health and safety, workplace security, and high-stress levels due to inadequate organization, PPE protocols or provision. They're concerned about respect for their personal rights and safety.
Whether between colleagues or rolling downhill from the boss, bullying in healthcare is destructive to a vital profession and ultimately, negatively impacts patient care.
IBSIG (Independent Business Specialty Interest Group) Cares About Bullying in Nursing, And We Believe You Should Too
Calling out workplace violence isn't always easy. For many people, it's difficult to identify as well. During the unusual circumstances in recent months, healthcare workers have spoken out publicly and privately about their management requiring nurses to work without adequate PPE, without proper precautions taken for COVID-19 patients, and without a sense of personal safety for themselves and their families.
An anonymous nurse reported to IBSIG executive members that she had been:
"...given one n95 mask- not fitted according to protocols- and told to wear it for the duration of her shift, caring for multiple patients on a COVID-19 designated unit."
Her orders to reuse gowns in close quarters with COVID-19 patients in non-isolation rooms (without negative pressure) raised concerns.
That's because nurses know what high-level precautions should look like, yet some have been advised by their management that these steps are not possible or not available.
Additionally, if a nurse has conditions such as metabolic health issues, pregnancy, or elderly family at home, should she have a right to insist on additional precautions? Does she have the right to refuse care?
The Right to Know ensures nurses and other health care workers are informed about hazards in their workplace, receive appropriate training and equipment to work safely.
As it relates to COVID-19, nurses have a right to up-to-date data, including:
- Patients and workers confirmed positive
- Number of staff and patients exposed
- Number of patients and workers isolated
- Daily fatality numbers
- Analysis of how patients and staff were exposed
- And information on the availability of PPE supplies
Provincial nurses' unions have outlined these rights, including work refusal, based on provincial OH&S legislation, yet a growing number of nurses are reporting that they do not feel their management respects these rights, and they fear job insecurity or punitive action if they complain.
Unfortunately, too often now, we at IBSIG are hearing stories from fed up, frustrated, and burnt out nurses looking for new avenues of practice and business to escape the extreme stress of nursing in the time of COVID-19. We want to draw attention to this issue and encourage an open conversation about it. Nurses need to be heard, to feel supported and to have a sense of agency in their workplace safety, as per C. Arnott, RPN, President, IBSIG who receives calls daily for mentorship.
'Nurses Eat Their Young'- Right of Passage or Unacceptable Bullying?
You may have heard this phrase, "Nurses eat their young" while still in school or encountered it in your healthcare facility. Textbook "lateral violence" can occur in any care setting and is well-documented in the medical literature.
Bullying ranges from colleagues in a position of power creating unbalanced or unfair work assignments, intimidation and harsh criticism, mockery, passive-aggression, or exclusionary behaviour. Nurse bullying may be systemic in some facilities to the point that it contributes to nursing shortages.
A phenomenon that is true for nearly every profession is that people who feel attacked, fearful, and intimidated each day tend to find reasons not to go to work. Eventually, they seek opportunities elsewhere.
Clinical and leadership literature document bullying outcomes in healthcare correlated with increased patient risk, lower patient satisfaction, greater nurse turnover, and ultimately, millions in additional facility costs.
Bullying has no place in a profession intended to be caring and dependent on genuine teamwork. So, why are these instances apparently increasing?
Today, nurses report feeling emotionally and mentally abused not just laterally but vertically by their managers, charge nurses or physicians they work with.
Some would suggest that the circumstances of this Year (working during a pandemic which we are ill-prepared for) has led to increased levels of personal stress, depression, anxiety, and other mental health problems.
What is typically discussed in terms of isolated bullying incidents and interpersonal team dynamics, is now a widespread, serious problem across the board in Canadian healthcare.
Nurses have historically taken more than their fair share of abuse. However, current pandemic working conditions have led to increased reports of bullying and pose a significant threat to mental health.
We are facing burnout at high rates, and bullying that threatens jobs, personal safety, and ultimately, crucial quality of care.
Why is Bullying in Nursing So Pervasive Today?
When the source of unprofessional behaviour is someone you report to, who has your job security in their hands, addressing the issue directly may be intimidating, to say the least. Nurses tell us at IBSIG that they don't always feel empowered to follow their institution's policies for reporting bullying or abuse.
An unfortunate side effect of feeling powerless is captured in the old saying, "*Bowel movements* roll downhill."
Consistently feeling attacked and diminished may lead to "oppressed group behaviours," such as lashing out at members of one's own group. Not having support in place sometimes leads people to adopt the mindset that it's each individual for themselves. Isolation, depression, irritable and unprofessional behaviours result, and a breakdown of the nursing team is the outcome.
We believe that the vast majority of nurses are dedicated team players and are distinctive as genuinely caring members of society. There have typically been just a few outliers, "bad apples," to ruin the profession for others.
The topic of bullying in nursing has been a critical one for many years because one bad apple is too many. However, these unprecedented times have us concerned about the more pervasive spread of this issue tied to overall burnout and nurses seeking options outside their profession.
While IBSIG is proud of our mission to lead the way in business and entrepreNURSEship™, we also strive to see nurses fulfilled in their work wherever they truly want to be.
The majority of nurses are sincere in their efforts to avoid patient errors, provide evidence-based and high-quality care. They just want to feel safe at work, function as part of a healthy team, rely on their management to support them, and enjoy their work.
They want to be healthy and well, as their patients do. They have a right to this, and to a bully-free work environment. We owe it to IBSIG members and all nurses to have this discussion out loud, urgently, and with a focus on practical solutions that restore their confidence in the nursing profession, from the top down.
CNO Standards, Code of Conduct https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf
COVID-19 update: Standard of care and nurses' accountabilities
CNO acknowledges that it is an unprecedented time in health care. We understand that you are stressed and may be concerned about being able to maintain standards of nursing practice. We want to assure you that the standard of care is always considered in context. The standard of care can evolve with the dynamic nature of the pandemic, including that resources may become scarce or absent.