Welcome to episode thirteen of the Ausmed Handover podcast. We are constantly told that bullying has reached epidemic proportions within the nursing profession on a global basis. But the statistics don’t tell us anything about exactly who the bullies are. So just what are the attributes of the archetypal bully, where do they lurk, and what’s it like to be one?
Hello and welcome to the Ausmed handover podcast. My name is Darren Wake, and in this episode, I want to ask the question: what’s it like to be a bully?
… so after admitting those six patients I took Mr Jacobs back from the ICU and settled him into the ward. Unfortunately, he arrested soon after that and we had to do CPR on him for almost an hour and then transfer him straight back to the ICU after we got him back. I talked to his wife for nearly an hour about what happened before she went home and then looked after the six post ops after their procedures. But don’t worry, everything is done and up to date.
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Have you experienced that before… those handovers where your report is met by a deafening silence, a complete failure to acknowledge that you’ve done a good job? Those times when you walk away from your shift with no sense of that what you did had any value at all, no simple feedback, no feeling that, let alone did a good job, that you even performed adequately over the duration of your shift?
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Well, that’s because you’ve been subject to one of the oldest of methods used to bully staff in nursing.
But, bullying is a term that we are quick to use, and we are often just as quick to point the finger at those colleagues of ours we regard as bullying us in a given situation, and, if we are to believe the statistics, there certainly are plenty of them about.
But do we really know what bulling is? There’s literally millions of resources out there that can tell you about this, but most, if not all of it is very poor quality material, and is mostly either simple personal opinion, or regurgitated and recycled journalism and rhetoric that neither addresses the problem, nor offers any kind of realistic solution.
In this episode of the handover podcast, I’m going to review some of the research that has looked into bullying over the last several decades and see where we are today, dispel a lot of the myths that cloud the topic, and I’m going to really pick apart some of the statistics, because when you look a lot deeper into what they reveal, it shows where the bullies hide: and it’s not as simple as you might think, Oh, I’m going to look at the psychological profile of a bully too. And then I’m going to smash it.
Bullying in nursing has been around for a long time. I’ve found studies going back to the 60’s that talk about nurses feeling bullied in the workplace, but the real explosion in literature was from the 80’s onwards, which is not so much a reflection of an explosion of bullying in the workplace, but rather the rising ability of nurses to start publishing papers and doing research, and the rise in popularity of qualitative research.
No one really knows what the incidence of bulling was back in the early days of nursing, and in many respects, I don’t feel that such research would be relevant anyway: the structures of both society and nursing, and the cultural hierarchies of the early 19th century and before, and the kind of language used and absence of any really robust qualitative research methodology would make any kind of data very difficult to interpret.
What we do have is a fair bit of good data on bullying in the profession from the 80’s onwards, mainly from the UK, the USA, Taiwan, Finland, Europe, Australia and, believe it or not, Iran.
Let’s have a look at some of these statistics, country by country and see what the incidence is.
In the UK, around 20% of nurse’s report being bullied in research conducted by non-nurses, but other studies by psychologists put that figure at 44%, and still others at 42% and 38%. I’ve also found a large study that shows 97% of nurses have experienced bullying.
In Australia, some major studies report that 95% of nurses are bullied. I’ve also seen in house reports that put the figure for one health service at 77%.
In Korea, the figure is 94%.
In Norway, only around 5% of nurse’s report having been bullied.
In the USA, the most recent studies show that 85% of all nurses have been subject to an incidence of bullying some time in their career. However other studies put that figure at around 13%.
Other observational studies by anaesthetists put the figure at 100%
In Iran, around 22% of nurse’s report having been bullied by their colleagues and managers.
In New Zealand, around 87% of nurse’s report either being bullied or observing bullying behaviour.
So it’s all over the place.
In comparison, large studies academics show that between 16 and 40% have been bullied, in IT between 4 and 85% of staff report being bullied, in medicine between 40 and 80%, and in teaching 14 to 35%. So their stats are all over the place as well.
But, if we are to go by these statistics, it’s a serious problem. I don’t have to go into the effects of bullying, they are well known, but aside from the long term effects on staff, around 60% of newly graduated nurses in the UK and Australia will leave the profession within two years of graduation and cite bulling as the main reason.
In response to this, there have been several concerted efforts by governments, unions, facilities and wards over the years to deal with this issue.
I’ve been a nurse for a long time, and over this time I’ve seen zero tolerance programs, legislation introduced to make bullying a criminal offence, workplace education programs, intervention teams of people created to deal with the problem, restorative justice, anti-bulling officers, union programs, human resource policies, guidelines, statements, mission statements, statements of purpose, statements of staff rights, memorandums of understanding, and on and on and on.
I’ve seen these instituted repeatedly in their various forms since 1985, and I’ve even read about one or two nurse bullies being charged and convicted of bulling, most notably in Scotland in the 1990’s.
But, how can I sum up the end result of these millions and millions of dollars spent, and countless millions of words of rhetoric.
Well, a meta study last year looking at worldwide bulling over the last 30 years showed that there had been a huge increase in the awareness of bulling: heaps of nurses were quite aware of what bullying was, and what their rights were if they were subject to an incidence of bullying, what the legal and administrative penalties of bullying someone ese are, and what a bully is, but overall, there had been no reduction whatsoever in the global incidence of bullying in nursing. In fact, it’s on the rise, and it’s becoming increasingly common to read smaller new studies quoting figures in excess of 75% of nurses being subject to bullying in their job.
Which is starting to make me think, there are a lot of nut jobs out there waiting to demean and harass their fellow staff members. So just what do they look like?
Well, there are fair few publications out that go to great efforts to construct a profile of the average bully.
From what I read, they have the following traits:
Sounds about right, doesn’t it. The problem is, there’s no research whatsoever to back any of this profile up. Nothing. Zip, nada.
There’s absolutely nothing in the literature to suggest that bullies have a consistent nut job, la la, Hannibal lector psychological profile that makes them easy to identify in the workplace.
In fact Buon and Buon point out that profiling bullies has probably been one of the most damaging programs of the anti-bullying campaigns, as everyone excludes themselves from being a bully by going through the list.
How many of you listened to that and thought… yep, yep, yep… oh crap, that’s me!
And we need to tie that carefully into the next section of this episode.
One of the grand flaws of virtually all research into bullying is not so much to do with the methodology, but rather the sensationalising of the way results are presented.
Most research breaks down incidents of bullying into whether the respondents were bullied in the last month, six months or over a period of years, and often include a question on whether they were subject to a single incidence of bullying in that time.
Often, these results are presented in a way that doesn’t make this clear, and single incidents of perceived bullying are taken to be a broad statement that a nurse is bullied.
This becomes very evident when the statistics get really high. If 90% of nurses in one work area report being bullied, does that mean that 10% of the staff are absolute bastards?
Of course not. What it does mean, and what can clearly be interpreted from all of these results is that the role of the bully is fluid within any given workspace. That is, even if the staff turnover is static, nurses unknowingly play the role of the bully in the eyes of another nurse for brief periods of time.
That is, maybe one day you’re not in a good mood, and you give your colleague the silent treatment after they hand over a particularly busy shift to you. You do just like the little example I used to open this podcast. And you do it just once. Never before, never again. But just once, you make them feel like crap.
But once maybe, just once, in the eyes of your colleague you’re a bully, and if they were polled tomorrow in a research project, that single instance would be enough for them to state that they had been bullied in the workplace, and the stats go up.
And do you fit the profile of the average bully? Absolutely not. Are you a bully: yes, but only for a moment!
But then none of your colleagues are either. But, according to statistics, at least half of them are bullies.
I’ve done this, this silent treatment, I’m ashamed to say. Not often, but I know I’ve done it. I’ve deliberately avoided giving a hard working colleague of mine the satisfaction of knowing they had worked hard and done a good job on their shift. Just because I was a little off in my mood for the day.
Am I a bully no. But for five minutes one morning I was.
And this is why the statistics for bullying are so terrible. There aren’t, hopefully, a small group of individuals out there that are sheer psychopaths making life hell for everybody else on their ward. Rather, it’s a fluid situation. We all become a bully once or twice a year, just briefly, and those who are bullies get bullied in turn, and in the interim period between these little events, we work together and our relationships are more or less collegial.
So there’s no point looking for the archetypal bully on your ward. Yes, there are difficult individuals on any ward that can make life hell for you, but we know from very large studies over nearly a century that they, in any workplace will only comprise 5% of the workforce, rarely less, and rarely more, the other 65% of the bully cohort is completely fluid, with the role of the bully being filled by various staff at various times, with no consistency or identifiable pattern. You and I were probably part of that cohort to: even if we made someone uncomfortable for just five minutes after their handover once in our career.
And that leads us to the biggest problem of all: the identification of bullying as a ‘cultural’ problem.
Workplace culture holds the same status as middle managers as a symbolic scapegoat for everything that is wrong with the nursing profession. It’s an abstract concept that we can hand the blame for so many things on. But the problem, like the nameless entity of middle management, is that ‘culture’ cannot facilitate change.
What all nurses have to realise is that no matter how nice you are, just five minutes of silence, or a careless allocation of patient load, a careless word or a deliberate non constructive criticism probably contributes to the horrendous statistics of bullying nursing, and that’s because everyone is aware of what bullying is.
But no one thinks they are a bully.
And if no one is prepared to take some degree of responsibility, then change will never happen.
If you want to stamp out bulling in nursing, then don’t wait for intervention and awareness programs to do it: all they have done is make us look for the mysterious bully X, and don’t wait for the culture to change by itself.
The only way bullying will end is if you dispense with the notion you’re not a bully, because statistics tell us clearly that at some time, some where you probably have been a bully to someone, even if it was for just a few minutes and even if it was just once.
So from tomorrow, think before you act or speak, if it doesn’t make a positive contribution to the workplace, then don’t say it. Simple as that.
This is the Ausmed Handover podcast, my name is Darren Wake, and thank you for listening.
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