The pervasiveness of nurse bullying: 7 key thoughts

Nurse bullying and incivility in the operating room is a real and seemingly ubiquitous problem, as evidenced by a recent discussion hosted by the Association of periOperative Registered Nurses and streamed live on Facebook.

Gayle Davis, AORN's director of corporate communications, spoke with Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the executive director and CEO of AORN, and Lisa Spruce, DNP, RN, CNS-CP, ACNS, ACNP, FAAN, AORN's director of evidence-based practice, about bullying and incivility in the OR and its effect on patients and the profession.

Here are seven key points on bullying, pulled from AORN's conversation. See the full video here.

1. Bullying isn't always obvious. Bullying comes in many forms — including the oft discussed issue of surgeons throwing instruments or yelling in the OR — but there are more subtle forms of bullying, known as incivility, according to Dr. Spruce. "Nurses are such a caring, compassionate and kind group of people, who treat our patients amazingly well, but then sometimes with each other we don't do so well," she said. Examples include eye rolling, being impatient when training a new nurse, or not inviting a newcomer to lunch with the group. "Over time, that [can have] an impact on the new nurse," she said.

2. It affects nurses personally and professionally. Bullying and incivility both can have a negative effect on recruitment and retention of new nurses, or could even cause some nurses to consider leaving the profession all together, something that happened to Ms. Groah early in her career. "When I was a young nurse in the operating room I experienced [bullying] myself, and I did have times when I felt very disrespected, both from my colleagues as well as other people on the team," she said. "I must admit there were times where I wasn't sure nursing was really the profession for me because it just took me so far back to think that we could treat each other this way."

3. Nearly all OR nurses experience it. Ms. Groah said bullying "is happening every day in the operating rooms across this country."

People watching the live-stream discussion agreed, noting in the comments their own personal experiences with bullying in the OR. One such commenter wrote, "Yes, it is happening every day! It is as if there is a cultural tradition of abuse and bullying in the operating room."

Another viewer commented: "I think this is a cyclic problem, bullying exists and staff leave due [to] it. Management fails to deal with it because the bullies usually have been there the longest and run off the new nurses. Management does not want to lose the staff that has been there the longest so they don't deal with it. I have personally been affected by this and it permeates the OR workplace."

4. It impacts patient safety. Bullying and incivility doesn't just affect job satisfaction, it can also negatively influence patient safety, especially when the bullying happens after someone speaks up for a patient on their behalf. "There is potential for patient harm in those situations…if you feel like a fool for bringing something up, the next time around you're not going to be so likely to speak up," Ms. Groah said.

5. Managers need to be responsive. Unfortunately, when nurses report a bullying problem to their manager, it often goes unaddressed. One survey of nurse managers, referenced by Ms. Groah, found that just 38 percent of managers indicted that they ever did anything about comments or complaints of bullying.

This is likely because managers tend to lack the tools necessary to be helpful and get a handle on these situations. "I think that managers need to understand what's happening in their operating rooms and more important than just understanding it, they need the tools…that will help them assist with changing the environment," Ms. Groah said.

6. Bullies may not know what they're doing. Ms. Davis shared an example of one AORN member who, after attending an expo on nurse bullying, realized she had been a bully to other nurses in her life. "It made me realize that maybe the bullies don't even know they're bullying."

7. It's not a lost cause. There are materials available to train nurses on how to manage bullying and change workplace behavior. "It's not something we should just walk away from, it's something that can be trained to create a stronger team feeling," Ms. Davis said.

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