The first step to eliminating nurse bullying, burnout in hospitals

Nearly 3 million people in the U.S. are registered nurses, according to data from the Bureau of Labor Statistics, and most of them (61 percent) work in a hospital setting. Creating a healthy work environment for those millions of nurses should be a top priority for employers, according to Mary Jo Assi, DNP, associate CNO of Press Ganey.

Dr. Assi recently joined Press Ganey from the American Nurses Association, and strengthening nurse resilience and engagement are among her primary goals at Press Ganey.

Some of the biggest issues in nursing today — recruitment, retention, burnout and bullying, for instance — can be addressed by focusing on creating a healthy work environment for clinicians, she posits.

A healthy work environment in a hospital is "one in which any clinician is able to do the work that they've really signed up to do," Dr. Assi says. There are several characteristics of a healthy work environment for nurses, including:

  • Sound staffing levels
  • Access to healthy food
  • Autonomy in practice and working at the top of licensure
  • Scheduling that allows for proper rest
  • Well-laid out units
  • Leadership support
  • Shared decision-making

Far too often, however, the hospital environment is not conducive to nurses' needs, and therefore does not promote resilience and engagement. In addition to negative effects on overall well-being, nurse burnout and disengagement can adversely affect patient care. Hospitals must do more to identify the environmental factors that contribute to nurse burnout and alleviate them, according to Dr. Assi.

Burnout and work environment

Burnout is cited by many nurses as the reason they want to leave the profession. To combat this, several healthcare organizations are starting to focus on building nurse resiliency, and building a healthy work environment can help in that regard.

For instance, rest is an important factor in a healthy work environment. "Individuals that are working 12-, 14- or 16-hour shifts, it's really difficult for them to be up and on and where they need to be," Dr. Assi says. "We need to make sure people are getting sufficient rest to recharge and renew."

Staffing, breaks and vacation time are all ways that hospitals can make sure nurses have adequate time to recharge.

"People need [time to] disconnect from work … [They] can't be tied in 24/7 and be expected to be resilient and able to handle high levels of stress," Dr. Assi says.

Bullying and work environment

Nurse bullying — nurses bullying each other, or "eating their young," as well as nurses being bullied by other clinicians — is also a pervasive problem in hospitals that could be addressed by thinking about the work environment as a whole.

"I would say that incivility, bullying and violence … is connected in some ways to what is happening in the healthcare [work] environment," Dr. Assi says.

Nursing can be inherently stressful, and stress can lead to people being rude to one another. "Where you have high stress levels … people are less likely to be [as] civil to one another as we would expect them to be," Dr. Assi says.

Understanding that the environment in a hospital could contribute to nurses experiencing incivility and bullying is half the battle. To combat this issue, leaders must "develop a standard of behavior [and] protocols that say it is not acceptable in this environment," according to Dr. Assi.

Not only can having a healthy work environment address burnout and bullying, it can also have a positive effect on patient outcomes and HCAHPS scores.

"We know a healthier and stable workforce has better patient outcomes," she says — which is why creating a healthy work environment should be a top priority for hospitals moving forward.

Click here to see a 2015 Press Ganey whitepaper with more information.

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