Nurse Incivility and Bullying: How to Know the Difference
ANA’s Zero Tolerance Policies Playing Out in the Workplace
By Joan Fox Rose, MA, RN, contributor
The American Nurses Association (ANA) recently published a Position Statement on Incivility, Bullying and Workplace Violence, a document developed by the Professional Issues Panel, a diverse committee of 23 RNs who carefully defined incivility and bullying and the difference in the terms.
“We encourage nurses to look at the ANA’s definitions and recommendations under the lens of their own actions and inactions in the workplace,” said Jaime Murphy Dawson, MPH, ANA Senior Advisor, Nursing Practice and Nursing Environment. “We recommend they look closely at how they’re treated by their colleagues. Are colleagues' interactions positive; is there incivility or bullying and how are these actions and inactions affecting nurses personally and professionally?”
Incivility and Bullying Defined
Incivility and bullying have different definitions, so interventions are grouped accordingly, Murphy Dawson explained. Incivility refers to rude and discourteous actions like gossiping or spreading rumors, or inactions such as refusing to assist others when requested to do so. “Incivility can occur because nurses work in fast paced environments that may involve life and death situations, numerous workplace hazards and long hours,” she said. “These factors can result in incivility caused by stress and fatigue.”
Bullying goes one step further because this action is intentional, happens with more frequency and intensity and is carried out in an effort to offend, distress and humiliate an intended recipient, she explained. Examples of bullying include hostile remarks, verbal attacks, taunting, verbal intimidation, and withholding support.
How to Prevent and Intervene:
1. Primary prevention aims are designed to prevent incivility, bullying and workplace violence altogether.
2. Secondary prevention aims to reduce the impact of these negative actions on recipients.
3. Tertiary prevention aims to reduce negative consequences through reporting procedures and employer assistance and counseling programs.
“Interventions are approached by learning predetermined phrases, or a cognitive rehearsal of responses developed to deflect incivility and bullying,” Murphy Dawson said.
Nurses experiencing these situations are advised to address wrongdoers by using the above mentioned skills and/or by seeking colleague support. Interventions also include sharing pertinent information with employers to set up or refine policies that prevent bullying through follow through interventions to meet the goal of zero tolerance.
How One Hospital Is Leading the Way
Massachusetts General Hospital (MGH) is designated as a Magnet hospital and ranked number one in the nation for 2015-2016 by U.S. News and World Report; the 999-bed, Boston-based hospital is noted for excellence in patient care. Workplace violence prevention and the goal of zero tolerance are a vital part of hospital services and practices.
“We consider bullying as part of the continuum of disruptive behavior that’s closely related to and part of workplace violence,” said Gino Chisari, RN, DNP, and Director at MGH’s Norman Knight Nursing Center for Clinical and Professional Development.
Workplace violence and bullying are discussed during general orientation through a variety of learning experiences presented through role playing and simulation, Chisari explained. Knowledge and skills acquisition goals are met through on-going educational programs.
“MGH nurses (staff and travel nurses) learn how to manage aggressive behaviors and deescalate potentially violent situations by engaging with conflict in a healthy way to achieve positive resolution that increases individual and organizational growth,” he said.
Members of the MGH Department of Quality and Safety, Christina Stone, RN, PMHCNS-BC, Nurse Director, Blake 11 Inpatient Psychiatric Unit and Adele Keeley, RN, MA, Nurse Director, Inpatient GYN Oncology Unit present conflict management/conflict resolution seminars. These seminars include discussions about professional behavior, such as showing respect for others, cooperation, teamwork and positive conflict resolution through crucial conversations. “Because when nurses stop talking patient care information can be missed and that compromises patient safety,” Stone and Keeley agreed.
When communication breaks down and conflict can’t be resolved staff members are encouraged to seek managerial counsel. Should an incidence of extreme disruptive behavior occur, a disruptive behavior report is filed with the Department of Quality and Safety. Employees involved in this negative behavior meet with managerial staff experienced in conflict resolution issues. During discussions they’re reminded that when they signed annual performance evaluations they agreed to behave in a professional manner while at work.
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