Nurse bullying: How hospital leaders can curb conflicts among staff

In addition to physicians and nurses feeling burned out from long hours and tedious administrative duties, a far more subtle but pervasive issue is plaguing hospital staffs — nurse bullying.

At Becker's Hospital Review Health IT + Clinical Leadership conference May 10 in Chicago, a panel of nursing and healthcare leaders explored where and how nurse bullying occurs and prevention in their organizations. The panel included:

  • Krista Whiting, executive recruiter of clinical nurse leadership at recruiting firm Parkwood International
  • Kylie Kaczor, MSN, RN, vice president of clinical and regulatory affairs at National Medical Billing Services
  • Michael Levitt, CEO of leadership consulting firm Breakfast Leadership
  • Greta Rosler, MSN, RN, director of patient experience at Danville, Pa.-based Geisinger

Nurse bullying not only happens between nurses, but also can happen when hospital administrators don’t support or punish nurses, the panelists said.

"I found a lot of this behavior comes down to a lack of boundaries within an organization coming from the top down," Mr. Levitt said. "Organizations need to value protecting their staff and have a culture where people can go to work without second-guessing themselves. It's one of the few sectors where if there is a mistake, people can die."

Characteristics in an organization that foster nurse bullying include nurses being targeted in gossip among hospital staff; personality conflicts and gatekeeping, which is when co-workers withhold information that prevents other employees from succeeding at their jobs.

"As long as leaders allow this to happen, it will keep happening," Ms. Kaczor said. "When you assume a leadership role, you give up the right to sit back and do nothing. You have to get involved. It's not your role to be liked by everyone, but it is your role to treat everyone equally across the board."

To help prevent these behaviors, the panelists discussed several ways organizations can identify nurse bullying as a problem.

"Organizations can look at their retention and turnover rate, particularly for staff that have been there for two years or less," Ms. Rosler said. "They may hold out 18 to 24 months, but if you're seeing a turnover that exceeds this rate, look into bullying as the issue."

Ms. Kaczor recommended hospital leaders look at medication errors, patient outcomes and infection rates to determine whether staff performance is suffering due to nurse bullying.

"When people are in these negative environments, being drained emotionally and physically, you'll see their performance dim," she said.

A hospital's chief nursing officer also plays a significant role in how organizations can address nurse bullying, Ms. Whiting said. "It's always about the CNO — when beginning a job, nurses ask themselves whether the CNO is someone they can work with. To keep staff on board, organizations need to give feedback to nurse leaders and tell them what they can improve."

Ms. Kaczor suggested organizations hold quarterly meetings where leaders can both celebrate staff successes and reiterate expectations of behavior and performance. "Make it clear from a leadership position that bullying and negative attitudes are not acceptable behaviors."

Ms. Whiting cited six main reasons people leave a job.

"People leave a job when they are looking for challenge, location, advancement, money, different people to work with or stability, but people is No. 1," she said. "You can't coach a happy nurse," she added, but understanding the importance of how co-worker behaviors affect employee engagement could help retain nurses.

Addressing nurse bullying in the workplace is not only crucial to holding employees accountable for their actions and maintaining a safe work environment, it’s also critical to ensuring quality patient care, the panelists said.

"As a sector, we need to start taking care of ourselves and making sure we have the right environment for our nurses and physicians," Mr. Levitt said. "Eventually, we're going to be on the other side of that hospital bed."

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