What? Nurses as Bullies?

by Myra Saturen
October 04, 2013

Did bullying in nursing start with Florence Nightingale? Mary Pat Szutenbach, Ph.D., RN, CSN

According to Mary Pat Szutenbach, Ph.D., RN, CSN, some teachings of "the lady with the lamp" contributed to a professional culture fostering uncivil behavior among a profession that people enter with the sincere desire to care for others. 

According to the website American Nurse Today, up to 65% of nurses have experienced or witnessed nurse to nurse bullying.  Whether it's called lateral hostility, lateral violence or something else, the behavior causes low morale, employee turnover, poor patient satisfaction, and lower care outcomes.

Szutenbach gave an interactive keynote talk about the phenomenon at a daylong conference on October 4 at the Fowler Family Southside Center.  "Nurturing and Flourishing in Nursing: Understanding the Barriers to Nurturance in Nursing" engaged nurses and administrators from area hospitals in recognizing, understanding the roots of and eliminating this problem.  The author of "Bullying in Nursing: Roots, Rationales and Remedies," Szutenbach is from Regis University, Loretto Heights School of Nursing in Colorado. 

"What's going on?" Szutenbach asked.  "We are the caring profession, yet we aren't caring among ourselves."

Szutenbach defined bullying as oppressed group behavior: people who cannot fight those more powerful than they, aim the resulting anger against each other. What are the ingredients at the root of this uncaring attitude?  

  • paternalistic structure.  Until recently, physicians tended to be male, and traditional gender roles held sway;
  • enculturation.  Students learned to follow a hierarchical matrix from the beginning-in school, clinicals and on their first jobs;
  •   incomplete or inaccurate awareness or acceptance of bullying as normal in the profession;
  • socialization into the belief that nurses cannot be assertive or supportive of one another.  "Nurses are the largest body in a health care setting, but have the smallest voice," Szutenbach said.  "We haven't tapped the power of our numbers and capability." 

And how, of all people, did Florence Nightingale set the groundwork for subservience and its offspring--resentment taken out on colleagues?   Szutenbach referred to Nightingale's policy of total obedience to physicians.  She said that Nightingale's ideal of submissiveness, combined with powerlessness, lack of recognition, and reduced self-esteem, has outlived its usefulness. 

To explore their own experiences, participants broke into brief discussion groups.  One nurse said that his reluctance to ask his colleagues questions stemmed from having been chided for doing so.  "You need to learn this for yourself," he was rebuffed.  Another nurse described being ostracized because she had different ideas about performing tasks.  A younger nurse told of being ignored when, overwhelmed, she appealed to her colleagues for help.  One conference-goer recalled apprehension on the faces of patients who witnessed nurses' conflicts:  "If that's the way they treat each other, how will they treat me?" 

Participants also did a silent, unshared writing exercise to examine bullying or contributing to bullying on their own parts. 

Nurses often don't recognize that they are bullying, Szutenbach pointed out.  Some think: "That's how I learned; that is how you should learn."

She advised that the most productive way to handle being bullied is to avoid wallowing in resentment, but instead to stash grievances in a "bitter bag" and tossing that bag away.  She further suggested:

  •   keeping a journal for recording rough spots in a day;
  • trying to understand what happened;
  •   having an open and non-punitive conversation with the bully and others;
  •  following a relationship-based care model overall.  This model includes knowing your triggers, accepting your own behavior (you may have unwittingly contributed to undesirable situations), not jumping to conclusions, resisting blaming, taking account of your environment, listening, finding common ground, saying thank you when someone helps you, and sharing credit with others. 

Szutenbach and the nurses who attended the conference discussed measures being taken on both local and national levels to eliminate bullying in nursing.  Several nurses said that their institutions have found ways to mediate conflict in a more open, productive way and to minimize disruptive interpersonal dynamics.  The American Nursing Association has formulated standards of nurse-to-nurse interaction.  The major component of these standards of collaboration include partnership, valuing of experience, power and respect on all sides, recognizing and accepting all spheres of responsibility, mutual safeguarding of interests, common goals, trust, and recognition.  

The conference also included presentations on mindfulness and how to change your work environment from toxic to positive. 

Northampton Community College is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association.  The conference was a project of Northampton Community College's Center for Business and Industry/Healthcare Education. 



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