Bullying in the nursing profession: Can mentoring ameliorate the ill effects?

Introduction

Workplace bullying is a problem that is gaining increasing attention from practitioners and scholars alike.

Although there is no universally accepted definition of workplace bullying, with differing schools of thought on some key aspects, the characteristics that tend to be agreed on usually include that it is: “harassing, offending, socially excluding someone or negatively affecting someone’s work tasks”.1

Workplace bullying has a number of negative consequences for those affected, as well as for organisations.2 These include:

• decreased productivity and morale and associated employee absences and high turnover;
• poor team dynamics;
• reduced trust, effort and loyalty from employees;
• poor physical and mental health;
• and financial impacts resulting from legal costs or bullying investigations.3, 4, 5, 6.

Health-care employees are at a high risk of exposure to bullying.7 In particular, the risk for nurses is three times that of other health-care workers.8

The negative outcomes of bullying for nurses have gained heightened attention in recent scholarly and non-scholarly literature.9, 10, 11 Numerous surveys and interviews show that nurses are bullied in different ways, across different settings and to varying degrees.12

In New Zealand, research shows that nurses continue to be bullied.13 Studies on workplace bullying among nurses have focused mainly on the outcomes and consequences of bullying.14, 15 And while some instances of bullying are recorded and reported, many are not.16

In particular, the risk for nurses is three times that of other health-care workers.

Meanwhile, researchers and practitioners have suggested measures for addressing nurse bullying.17, 18, 19 One such suggestion is mentoring.20

However, while the benefits that mentoring can provide for bullied nurses have been identified, there is less in terms of examining how mentoring can address the issue of bullying in nurses, even less so in the New Zealand context.

In our research, we sought to put the spotlight on a range of workplace bullying experiences and explored the role of mentoring in addressing bullying among nurses. In this article, we present a summary of the key findings of our research on the role of mentoring in bullying and make recommendations for an enhanced role for mentors in addressing bullying.

Our research

The aim of our research was to explore bullying experiences of nurses and the influence, if any, of mentoring. A qualitative approach was deemed most appropriate, and aligned with the aims of our research.38

Data was gathered through open-ended semi-structured interviews, which enabled us to elicit responses to the questions we had prepared to guide the interviews, while also allowing for impromptu answers to probing and/or clarification questions.38

To understand what role mentors played in mitigating the ill-effects of bullying and/or preventing bullying, we sought to recruit participants who had either experienced bullying themselves or witnessed bullying in the preceding five years  and had a mentor to support them during the experience/s. There were no other exclusion criteria.

Nurses were invited to participate through an advertisement placed in Kaitiaki Nursing New Zealand magazine. Nineteen participants responded. They had worked in a range of settings when they had experienced or witnessed bullying – eight had been hospital nurses, seven had been district nurses, two in aged care and two in primary health care.

Our findings suggest that bullying is culturally embedded and accepted as a given in the nursing community in New Zealand.

In terms of ethnicity, 16 described themselves as New Zealand Europeans, two as New Zealanders and one as South Asian. All were women.

This project had full ethics approval and all appropriate steps were taken to maintain anonymity of participants. Braun & Clarke’s six-step thematic approach was used to generate key themes from the data.39

We found the participants were keen to share their experiences of bullying, and many of them keen to see these published. This emphasised not only the ongoing issue of bullying among nurses but also their desire to be “heard”.

Our research findings were similar to existing evidence about bullying both internationally and in New Zealand – that nurses are bullied by colleagues, supervisors and other health professionals;40 and that bullying has detrimental effects on the mental health and retention of nurses.41

We also found that nurses are subjected to a range of bullying experiences. For example, bullying can take the form of being reprimanded in front of patients, or being subjected to rude remarks about competence.

In all the accounts of bullying shared with us, the nurses being bullied quit their jobs due to mental health issues, inaction by authorities, frustration and/or a sense of defeat

Bullying, or horizontal violence, as it was sometimes referred to by the participants of our research, was ongoing across a range of health-care organisations and settings.

In most cases it was a more senior and/or influential person bullying a more junior and/or less influential person. Often the person bullying was a direct line manager.

Mentors were in most cases informal, either from within or outside the organisation. Some victims sought out mentors while others stepped in as mentors for victims when they saw a need. A summary of the key findings is presented below.

• Bullying begins early in the nursing career

There has been a focus on the bullying of student nurses in New Zealand, which has negative physical, mental and financial implications.23 We found that student nurses often began their work life with experiences of bullying:

“When Dana and I did our training, we were some of the first comprehensive nurses, and we weren’t treated very well by the hospital nurses. This is going back a while and you had to stand your ground and be aware that that [bullying] was out there.”

• It is often not reported

Bullying was often not reported due to fear — victims themselves could be fearful and so could witnesses to bullying, as well as those told about bullying by other victims. The organisational culture and systems heightened nurses’ fear to speak up:

“A bullying type of culture where people were afraid to speak up, and if you did speak up, then you basically had a target on your back. But it’s a very subtle type of bullying where the person being bullied is shut out, so they’re not part of the inner group that discusses things and then brings them as a fait accompli to meetings or they aren’t told the decisions that have been made and the rationale behind them, so this is a locking out type of situation that goes on.”

In line with the unfortunate, yet popular, catchphrase “nurses eat their young”,42 often performance appraisals were a source of bullying:

“The hard thing is that I’ve heard from some people that the performance appraisal is actually a mechanism for them to be targeted, to be bullied.”

• The systems in place support cover-ups

The other significant finding was that bullying was covered up and those bullied were often either overtly or covertly threatened. This meant that if a nurse overcame fear and hesitation to report instances of bullying, it did not lead to any negative outcomes or consequences for the perpetrators:

“So that was his way of covering those tracks. He also befriended quite a few people in his immediate area, he had a tight clique of people that he befriended, but outside of that everybody else was not included in this little sphere.”

• Mana-destroying and endless

At a personal level, bullying was mana-destroying, leading to a sense of shame in those bullied as it was done in front of other nurses, colleagues and even patients:

“So, in front of the patients and other nurses, they basically just absolutely belittle this nurse, inferring that she’d been doing nothing in the shift.”

Further, there was no respite from bullying:

“I was strong enough to be able to do so, but you can’t switch off because it’s continual [the bullying], it’s like a dripping tap.”

• Mental health issues

Mental health issues were reported by all our participants:

“I went through [my nursing training] and got it all done and got bullied really, really badly while I studied, it was real hell.”

In all the accounts of bullying shared with us, the nurses being bullied quit their jobs due to mental health issues, inaction by authorities, frustration and/or a sense of defeat:

“She resigned because the bullying had basically taken her out at the knees, was her description.”

• Influence of ethnicity

We sought to understand if the nurses had experienced bullying in any form due to their ethnicity. Most participants were Pākehā and were bullied by other Pākehā.

However, some reported that nurses of Māori, Pasifika and Asian ethnicities were targeted and berated for being of that ethnicity:

“Ethnicity, no, we’re both of the same ethnic makeup, but having said that, there was a nurse before me who wasn’t, she was Samoan, and she felt very much that her ethnicity was used against her and she was made to feel stupid.”

We also wanted to understand if ethnicity influenced the experience of mentoring; however this was not something that participants reported.

• Role of mentors

In response to our questions about the role of mentoring in instances of bullying, nurses mainly reported mentors being empathetic listeners, or that they themselves (as mentors) were good listeners to those being bullied.

There was a high level of trust and psychological safety involved in the mentoring relationship, and it was thought to help those being bullied:

“You know, I think it’s important to have somebody that you feel a rapport and comfort with, that you can sit down and have a gut laugh with, or, you know, get things off your chest, cry if necessary, and feel like you’re not, you know, there’s no lasting ill will around if you’re going to see them.”

• Is there a different more effective way of mentoring?

A noteworthy finding was that in a few accounts of bullying, mentors demonstrated assertive behaviours, going beyond nonconfrontational behaviour such as being a good listener. They advocated for their mentees and in some cases “took on” the bullies, including their networks and those covering them up.

Others who had witnessed bullying actively ensured their mentees were not self-harming or were getting the help they needed for mental wellbeing. These were individuals who took on a mentoring role, even though they were not approached directly by the victims.

Rather they were witnesses to bullying, either as colleagues or seniors. One of these mentors expressed it this way:

“I thought I really have to do something about this because with being in management, I do, and I’m not afraid to have difficult conversations.”

The desire for a mentor to be an advocate was also expressed by other victims and witnesses. When asked whether their mentors did enough, nurses said they would like an advocate, someone who would speak up because they could not.

One participant, who was a victim of bullying, explained this:

“If I went to them with an issue, and it would be, yes, they will listen and they will do that, but they didn’t advocate [completely] for you, is what I am trying to say.”

The way forward

Our findings support the notion of extending the existing scope of nurse mentors to actively engage as advocates for mentees. Indeed, advocacy is a professional expectation of nurses, both for patients and for each other.43

Such mentors may be formally assigned, such as preceptors, or they may be the more informal mentoring relationships that form along the career path of nurses.

This means organisations would need to focus more on awareness of these mentor roles and functions and to provide mentor training. Further, these mentors would need to have the influence to advocate without fear of consequences and backlash. Thus, senior leadership support would be necessary.

When asked whether their mentors did enough, nurses said they would like an advocate, someone who would speak up because they could not.

Participants reported that victims of bullying were encouraged by human resource departments to report bullying to line managers who were sometimes the bullies themselves, or close to the perpetrators.

So, the existing institutional processes that do not lend themselves to bullying being discussed in a safe space, need attention and modification. Clear human resources policies and guidelines on reporting bullying need to be established to mitigate such issues.

The importance of having a voice was emphasised by the participants, who were keen to have their experiences published so that others were made aware of the continuing issue of bullying among nurses. Being able to complete anonymous surveys was considered positive as it enabled them to report experiences of bullying to a wide audience:

“The only positive thing I feel, was there was a survey from [a national nursing body], it was a questionnaire.”

However, there was also a sense of dejection and participants felt no hope for change:

“I’d be interested to hear the outcome of the whole survey, but really, I can’t really see a resolution because I think it’s just people. Certain people, they get their rocks off by putting people down.”

Thus, there is a role for organisations to provide opportunities for staff to tell their stories beyond standard employee satisfaction surveys, and the results of these surveys need to be distributed around the whole organisation.

Further, these mentors would need to have the influence to advocate without fear of consequences and backlash.

External surveys provide an opportunity for victims to disseminate their experiences beyond just their organisation — this should be encouraged, and staff made aware of such opportunities. Further, victims of bullying could be invited to assist in the development of strategies for mitigating bullying, having had those experiences themselves.

Cannot afford further loss of nurses

We set out to explore the processes involved in mentoring of nurses who have been bullied or have witnessed bullying. We uncovered further stories of bullying and some key issues with the current mentoring practices in the context of bullying.

Based on these, we have highlighted our recommendations at an individual and organisational level for addressing bullying. Our findings suggest that bullying is culturally embedded and accepted as a given in the nursing community in New Zealand.

Empowering mentors, extending the scope of their operation as advocates, and gathering ongoing senior leadership support for them could be key in mitigating nurse bullying.

With the ongoing health workforce shortages, the health system cannot afford a further loss of nurses – something that is evidently happening much too often as a result of bullying.

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Vasudha Rao, MB BS (Bachelor of Medicine & Bachelor of Surgery), MBA, PhD, is a senior lecturer in the school of management, Massey University, Palmerston North.
Beth Tootell, BBus (Bachelor of Business), MBus, is associate head of the school of management, and a PhD candidate at Massey University, Palmerston North.

* This article was reviewed by Lorraine Ritchie, RN, MHSci, PhD, a nurse consultant in professional practice at Te Whatu Ora Southern, and a lecturer at the Centre for Postgraduate Nursing Studies, University of Otago.

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