Bullying Threatens Patient Care and Nurses' Careers

CINCINNATI—Bullying behavior directed at nurses from physicians and colleagues threatens patient care and is driving much-needed talent out of the profession, according to an article by a University of Cincinnati (UC) College of Nursing faculty member.

Dianne Felblinger, EdD, a registered nurse and associate professor of nursing at UC, examines the issue of bullying in an article published in the March/April 2008 issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing. In an accompanying editorial, she writes that it’s important for nurses to recognize abusive behavior and gain support to confront it in the clinical setting.

In an examination of studies on bullying in the workplace, Felblinger found that most verbal abuse in cases involving nurses is instigated by physicians. Fellow nurses account for the second-most number of instances, she found.

More than half of nurses surveyed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) reported that they had been subjected to verbal abuse and more than 90 percent had witnessed disruptive behavior such as verbal abuse or physical and sexual harassment, Felblinger writes.

The adverse affects of such behavior extend to patient care, Felblinger writes, citing a 2005 study in which 25 percent of health care workers saw a strong link between disruptive behaviors and patient mortality, and as many as 75 percent saw a strong link to adverse clinical outcomes.

Many nurses who are targets of bullying suffer from post-traumatic stress disorder with symptoms that can include low self-esteem, sleep disturbance and depression, Felblinger writes. Psychological effects may include a shame response, with inner-directed anger that results in revictimization. Or, the bullying target might direct their anger toward co-workers.

Ultimately, Felblinger writes, bullying can result in the targets feeling that they can never function normally or resume work again, leading to the departure from the profession of “bright, talented, and motivated women’s health and neonatal nurses.”

To overcome the adverse effects of bullying in the clinical setting, Felblinger writes, steps must be taken at both the individual and administrative levels. Boundaries of appropriate behavior must be set, and education is needed to raise awareness of everyone involved. She recommends the zero tolerance policy of the American Association of Critical Care Nurses (AACN).

Such interventions, along with clear reporting mechanisms and instant access to senior leaders who have the power to take immediate action, help establish an emotionally safe workplace that benefits both nurses and their patients, Felblinger writes.

The article has attracted considerable media attention, and Felblinger has been contacted by the Wall Street Journal and ABC News. “The topic is important,” she says, “and I would like to help do my part to be part of the solution.”

Like the nurses cited in the JCAHO study, Felblinger has witnessed bullying in the clinical setting. The worst case, she said, was when a doctor threw a used needle at a nurse and it pierced her skin.

While Felblinger feels the problem of bullying has gotten more overt over the years, she believes the trend can be reversed. “It’s just a matter of how we address it,” she says, adding that dialogue and collaboration are important in addition to clear policies and procedures.

“Civility saves lives,” she says. “It’s everybody’s business.”