NURSES

EAT GREET Developed by

the Anti-
THEIR YOUNG: A GUIDE Bullying in
Nursing Student
TO COUNTERING Committee
May, 2014
BULLYING IN NURSING

Table of Contents
Definition of Bullying .............................................................................................................................. 2
What Bullying is and what it isnt .......................................................................................................... 2
Bullying Understood ................................................................................................................................ 3
Strategies for Confronting Bullies in the Workplace ............................................................................ 6
Table 1 The 10 Most Frequent Forms of Lateral Violence in Nursing Practice ......................... 7
Table 2 Expected Behaviors of Those Who call Themselves Professionals .............................. 8
Direct and Non Direct Behaviors of Violence .................................................................................... 9
Symptoms resulting from Violent Behaviors .................................................................................... 10
Links to Resources ................................................................................................................................... 11
BCIT Resources: ............................................................................................................................... 11
Additional Resources ............................................................................................................................... 11
References ................................................................................................................................................ 12

4/24/2014
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Definition of Bullying
Horizontal violence (HV), or bullying, is not a new phenomenon in nursing, but has gained more
attention recently as nursing retention and recruitment become salient issues in health care
(Clarke et al, 2012).

The Canadian Nursing Association (CNA) defines HV simply as an act of aggression perpetrated by
one colleague on another colleague.(CNA, 2007). Others have defined it more broadly as any
unwanted abuse or hostility in the workplace characterized by the presence of a series of
undermining incidents in the workplace over time, as opposed to one isolated conflict in the
workplace. (as cited in Becher & Visovsky, 2012).

For the purpose of this guide, we have defined bullying as: A continuum of behaviors where
someone is subjected to social isolation or exclusion, and where negative behavior aimed to
torment, wear down, frustrate, intimidate and humiliate occur (Kivimaki et al. 2000, p. 656).
These behaviors, intentional or unintentional, could be targeted to an individual or group.
Bullying impacts other people as well as the victim, creating a culture of fear and inhibiting a
quality practice environment.

What Bullying is and what it isnt

What is bullying?
1. Personal attacks
Verbal and nonverbal aggression/insults
Derogatory names or comments
Sabotaging someones work
Vandalizing personal belongings
Physical/verbal threats
2. Addressing issues in an non-constructive manner
Participating in or spreading gossip
Shaming/humiliating someone in public or private for making an error

What is bullying not?
1. Constructive feedback
Providing guidance or advice about nursing-related performance and behavior
legitimate and timely evaluation of performance
2. Addressing issues in a respectful manner, through formal and appropriate channels
3. Expressing differences of opinion.

Bullying Understood
Many sources emphasize that bullying is not simply an interpersonal conflict, but rather
supported by the culture created, and by long term ignorance of unhealthy behavior. As a result
of this, people accept bullying as part of the job, and choose to either: leave, or stay and
participate in the culture as a bully or a bystander (Townsend, 2012). Although the individual's
role in bullying must be addressed (i.e. via education about the existence of the issue and conflict-
management strategies), a change of the management (leadership) culture that dismisses this
problem by failing to acknowledge it needs to be emphasized.
It is common for an organization to have zero tolerance of violence and bullying, however,
the incidences of work-related violence continue to grow. Instead of a commonly used way of
dealing with bullying that focuses primarily on individual or dyadic features of bullying, a
restorative approach is recommended (Hutchinson, 2009). According to Hutchinson (2009),
restorative justice strategies may be adopted in nursing education with the aim of fostering
shared responsibility to address norms and socialization processes implicated in bullying (p. 148).
The suggested efforts affecting the organizational culture for individuals practicing at different
levels are outlined below.

Individual efforts that can promote the culture of change (Townsend, 2012, p. 15):
Remember what it was like to be a new nurse. Treat new nurses as you would have
wanted to be treated as a newbie.
Make an effort to welcome new nurses and help them feel that theyre part of the
group
If youre being bullied, address the behavior immediately. Bullying might be so
ingrained in the workplace culture that bullies may not be aware of their behavior.
Use conflict-management strategies when confronting a bully
Identify the problem clearly when it occurs, and raise the issue at staff meetings.
Serve as a role model for professional behaviors

If youre the victim of a bully manager, here are a few actions you can take (Townsend, 2012, p.
15):
Keep notes on specific incidents and find out if others have complained about that
person.
If you decide to address the bully, control your own aggression or hostility. Using a
measured response helps you build a stronger case.
If you must work with this manager in a group setting, stick to neutral topics of
discussion or better yet, the topic of the specific meeting or project. Keep a blank
expression and stay calm so others in the room feel comfortable. This will help
prevent the bully from getting the better of you.
Once youve built your case against the bully, you can break your silencebut
dont go to the managers immediate superior. Most bullies are crafty enough to
maintain a positive image in front of their bosses, which may impair your
credibility. Instead, discuss the matter with a human resources representative or
another administrator.
Unfortunately, some bullying managers have built strong support systems and see
little reason to change their behavior. In this case, consider transferring to another
departmentor leaving the institution altogether.

Nurse managers and chief nursing officers role (Townsend, 2012, p. 15):
encourage staff to report bullying incidents
ensure that those who experience and report abusive incidents will be safe from
retribution
take action to discipline bullies, counsel victims, and implement corrective
measures to prevent recurrence
Bullying can be addressed by unit-based councils, with council members serving as
role
models for other staff members

Organization restorative strategies (as described in Hutchinson, 2009).
Focuses on bullying as a human violation which requires the perpetrator to make
amends within the context of supportive group that assists in restoration and re-
integration (Morrison as cited in Hutchinson, 2009, p. 150).
Involves those who have a stake in a wrongdoing collectively identifying and
addressing the harm caused through engendering active responsibility to put
things right (Braithwaite as cited in Hutchinson, 2009, p. 150).

The restorative justice approach involves bringing everyone who has any relation to the
incident together in order to reflect on the bullying effect, examine all possible factors influencing
the negative behavior, and develop strategies that would prevent its occurrence in the future
(Hutchinson, 2009). Restorative circles and restorative conference (more formal) are the two
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methods of restorative justice practice. Both involve provision space and supportive environment
where the issue can be discussed and reparative strategies formulated (Hutchinson). An overview
of restorative circle process is provided below.

An Overview Of Restorative Circle Processes (Pikas, 2002 and Braithwaite et al., 2006 as cited
in Hutchinson, 2009).
Rather than making the perpetrator a central focus, the acts of bullying are at the centre
The facilitator shares their concern for the harmed individual/s. After which, each
participant is asked to say what he or she knows about the situation, whether they have
actively or passively taken a role in the bullying, and what could be done to help improve
the situation
Disapproval of the bullying behaviour occurs in a direct but respectful way
Members of the circle take responsibility to curb dominating or abusive language and
ensure individuals are supported and not compromised by the actions or words of others
Members of the circle take responsibility to ensure the perpetrator acknowledges and
demonstrates acceptance of responsibility for the harm they have caused
The perpetrator is asked what they can do to repair the harm done and what steps they
will take to ensure they do not re-offend
It is important participants do not focus upon apportioning blame, but instead, focus
upon producing constructive strategies for changing the situation
Members of the circle make the necessary commitment to support the perpetrator with
the goals to make amends
Where the group themselves have colluded in bullying, each member makes a
commitment to not engage in the behaviour into the future

5 Key points

Lowenstein LF (2013)
1. Bullying in the workplace is a worldwide phenomenon

2.
3.
4.
It is not only senior staff who bully; often nurses bully each other
Bullying can often affect nurses ability to provide high quality care
Organizational characteristics are critical antecedents of bullying
5. Policies to deal with the possibility of bullying in the workplace and zero tolerance of this behavior are
needed

Strategies for Confronting Bullies in the Workplace

Immediately confront the abuser in a private area, and then document and report the incident to
the person in charge. Speak with confidence, in a firm, non-threatening, non-condescending
voice.

Confront the statement or action, not the individual.

Always identify the specific behavior that was offensive.

Always tell the person how the action made you feel.

Do not harbor bad feelings or grudges, and do not discuss the incident with colleagues.

Use I in place of you, to describe your feelings:

I am very hurt by your choice of words.
I do not appreciate the tone of your voice.
When we work together, I expect you will treat me with respect.
I will not discuss this further until you lower your voice.
I heard you gossiping about Bill.
I feel like a child being reprimanded when you use a condescending voice.
I believe you are insensitive to my needs when you avoid my questions.
I believe you do not trust my professional judgment when you question my
actions.
I felt belittled when you questioned me about Mrs. Smiths blood pressure in front
of her son.

Table 1 The 10 Most Frequent Forms of Lateral Violence in Nursing Practice

Griffin, 2004, p. 259

Table 2 Expected Behaviors of Those Who call Themselves Professionals

Griffin, 2004 p. 259

Direct and Non Direct Behaviors of Violence

Direct Violent Behaviors Indirect Violent Behaviors

belittling statement employing coercive
confrontational statement techniques
correcting someone in front of others failing to listen to another
creating conflict person
cruel acts/displaying outrage behaviors gossiping
deflating statement inflicting the silent
disrespectful/hurtful/insulting comment treatment
controlling or preventing an act ostracizing someone from
hostile behavior activities or conversation
insensitive/sarcastic comment Passive/undermining
interrupting conversation behaviors
intolerant behavior refusing to acknowledge
power play/bullying behavior someone rolling the eyes
pressure to act in a particular manner sabotaging someone
pressuring/threatening/coercing a person shrugging the shoulders
roughness/striking a person Sighing/groaning
rude statement tapping fingers while
sexual harassment someone is talking
throwing/slamming object turning away or avoiding
uncooperative behavior someone
verbal arguing yelling/whispering/whining using someone as a
scapegoat
withholding important
information

Symptoms resulting from Violent Behaviors

aggressiveness
anger
anorexia
calling out of work frequently
depression
headache
increased errors
insomnia Nausea/vomiting/diarrhea Nervousness/crying
paranoia
poor self-image
reduction in confidence resignation from employment Substance abuse addiction to cope
suicide
weight loss/gain

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Links to Resources
BCIT Resources:
These may be helpful if you suspect you are being bullied.

Who to talk to for advice:

Student representatives in your level

Counseling services at BCIT - Appointments are free and confidential, 604-432-8608 or
drop by SE16-128

Adrianna DIlio, Student Support Coordinator (BSN students), 604-432-8964
Adrianna_D'Ilio@bcit.ca> | SE12 423

Robyn Lougheed, BCIT Advocacy Coordinator, 604-456-1161 | advocate@bcitsa.ca

Paul Harris, Advisor, Campus Mediation Services(Harassment & Discrimination),
604-432-8476 | Paul_Harris@bcit.ca | SW01 - 2310

Additional Resources

Name Link
BCIT Harassment http://www.bcit.ca/harassment/
and Discrimination
BCNU C:\Users\A00897857\AppData\Local\Microsoft\Windows\Temporary
Internet Files\Content.Outlook\DLQ8D2BD\BCNU - BC Nurses' Union
(2).htm
CRNBC https://www.crnbc.ca/Standards/Pages/Default.aspx
WorksafeBC http://www2.worksafebc.com/Topics/BullyingAndHarassment/Home.asp


To raise your awareness regarding the nursing profession and its demands it is recommended you
review the CRNBC Requisite Skills and Abilities that must be met to practice nursing in BC
(https://www.crnbc.ca/Standards/Lists/StandardResources/464requisiteskillsabilities.pdf)

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References

Becher, J & Visovsky, C (2012) Horizontal violence in Nursing MEDSURG Nursing; 21(4), 210-214.

Canadian Nursing Association (2007). Violence in the Workplace [Position Statement]. Ottawa:
Author.

Colette M. Clarke, MSc, RN; Deborah J. Kane, PhD, RN; Dale L. Rajacich, PhD, RN; and
Kathryn D. Lafreniere, PhD (2012) Bullying in Nursing Education. Journal of Nursing
Education; 51(5), 269-276.

Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: an intervention for
newly licensed nurses. Journal Of Continuing Education In Nursing, 35(6), 257-263.

Hutchinson, M. (2009). Restorative approaches to workplace bullying: educating nurses towards

shared responsibility. Contemporary Nurse, 32(1-2). Retrieved from Ebscohost.

Kivimaki., M., Elovainio, M., & Vahtera, J. (2000). Workplace bullying and sickness absence in
hospital staff. Occupational and Environmental Medicine, 57(10), 656-660.

Lowenstein, LF (2013) Bullying in nursing and ways of dealing with it. Nursing times; 109: 11, 22-25.

Stevens, S (2002). Nursing workforce retention: challenging a bullying culture. Health Affairs 21
(5), 189-193. Doi: 10.1377/hlthaff.21.5.189 Retrieved from
http://content.healthaffairs.org/content/21/5/189.long

Thomas, C. (2010). Teaching nursing students and newly registered nurses strategies to deal with violent
behaviors in the professional practice environment. Journal Of Continuing Education In Nursing, 41(7),
299-310.

Townsend, T. (2012). Break the bullying cycle. American Nurse Today, 7(1).
http://www.americannursetoday.com/assets/0/434/436/440/8612/8614/8618/8648/c1d7657a-
4b54-4a43-98d6-05ceee4471cb.pdf

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