What is nurse bullying? How is that different from incivility? Aspen University’s Sam Boone sat down with Dr. Renee Thompson, founder of the Healthy Workforce Institute, an organization that works to “eradicate workplace bullying and incivility.” We cover various ways to recognize and remediate nurse bullying, the differences between bullying and incivility, and how leaders can initiate change.
Sam Boone (SB): Thank you for speaking with me today. Let’s start with your background in healthcare. Also, why did you form the Healthy Workforce Institute?
Dr. Renee Thompson (RT): I’ve been a nurse for about 29 years. I’ve done bedside nursing, home care, and worked for a managed care company. I was an educator. I was a frontline unit director, and I had a corporate job.
It didn’t matter where I worked. It didn’t matter what role I had. There was always a group of people who I swear were trying to set me up to fail or make it difficult for me. I just didn’t understand it. So I got to the point where I was in this corporate job, and I was responsible for professional development for about 10,000 people, and I would talk to a lot of nurses. All they wanted to do was talk about bad behavior and why people treated them so cruelly, and it reminded me of my own experiences.
It was around that time that I started doing a lot of speaking in front of audiences about bullying. I took a leap of faith, quit a great job, decided I was going to tackle this issue of workplace bullying and incivility in healthcare. From there, it just grew. I have faculty on my team, and we have an online academy. There are many ways that we serve our clients. But we were actually the only company in the world dedicated to addressing workplace bullying and incivility in healthcare alone. We don’t go outside of healthcare.
SB: Why do you think bullying occurs so frequently in nursing and other healthcare settings?
RT: Well, we see more disruptive behaviors in healthcare than any other industry, and I can’t help but think that one primary reason is it’s because it’s a high-stress industry. Think about it. We deal with life and death situations all the time and the unpredictability of patient care. We’re not always on our best behavior as human beings when we’re under a lot of stress. That coupled with the fact that we’ve accepted lousy behavior as the norm. People say all the time, “all nurses eat their young.” Everybody knows that. Every student nurse, when they start nursing school, has heard it. So we’ve normalized deviant behaviors. Well, he’s a really great nurse, but don’t get on his bad side.
I hate even to admit this or verbalize it out loud. But 90% of all nurses are women. Women aren’t always that nice to each other. We see a lot of this catty, gossipy, clique-like behavior more so in women than we do in men. Men aren’t off the hook here, though I’ve seen plenty of bad behavior among male nurses, too.
What are the signs that a fellow nurse might be getting bullied? What should someone look for?
People will call something bullying, and it’s not bullying. That’s probably one of the most significant issues that I find out there is that people call all bad behavior bullying. For somebody to say they’re being bullied — or for you to recognize that your coworker is being bullied — they have to be targeted. It could be one person or it could be a small group of people. Brand new nurses when they first start are at risk because sometimes the seasoned, experienced nurses will target new people or one specific person.
To also be considered bullying, the behavior has to be harmful in some way. If I roll my eyes at you, that’s not very nice, but that’s not harmful. However, if I refuse to help you, if I tell you to go look it up yourself, say “I’m not your mother,” or refuse to take a report from you because there’s nothing you can tell me that I can’t look up myself because you’re an idiot, that’s harmful to patients.
Thirdly, the behavior has to be repeated over time. It can’t be one time I get testy with you, or I get short with you when I’m in a stressful situation, especially in a crisis situation. We have to see this targeted, harmful behavior over time.
What I find is that there’s not a lot of bullying in healthcare. What I do see is an awful lot of incivility.
SB: That leads to an obvious question. What is incivility?
RT: It’s covert passive aggression. It’s gossip. It’s eye-rolling. It’s mocking. I think that’s what we’re all really dealing with. That’s all incivility and that, I think, is a bigger problem.
SB: How can someone recognize and address incivility?
Incivility is harder to address because, with bullying, you can identify that somebody is targeted, the behavior is harmful, and it’s been repeated over time. Chances are you can do something about that. Incivility can show up in sneaky ways, and it’s easy to dismiss.
I do a lot of confronting techniques. I think in general, people are so afraid to confront. They don’t know what to say. They don’t know when to say it or how to say it, so we do what’s comfortable. We do nothing.
A lot of times we don’t want to say anything because we’re afraid that the person will retaliate against us. I think the easiest thing to do, and this is where I always recommend that people start. Just get crystal clear on what that person is doing wrong. For example, it’s easy to say, “she’s so nasty,” or “he’s so condescending,” or “she’s such a bully.” But what is that person actually doing?
First, take a step back and get a clear idea of what the behavior is that’s bothering you. Once I get clear on that behavior, then I can verbalize it. “You’re yelling at me,” “You just criticized me in front of people.”, or “You called me a moron behind my back.” For example, when I’m giving this nurse a report, let’s say she won’t write anything down or type anything. She just crosses her arms and is tapping her foot impatiently. This when you can clarify, “You’re not writing anything down. You’re standing there with your arms crossed, and you’re tapping your shoe. Is there a reason that you’re doing this? Is there a reason that you’re giving me the silent treatment?”
That alone, believe it or not, can stop the behavior from happening again. I’ve had many examples of nurses who have said, oh my God, all I did was name it, and they stopped.
SB: That’s constructive advice. We have nurses at Aspen who are vocal about the importance of confronting nurse bullying. What can someone who is in a leadership role do to reduce nurse bullying?
RT: When I started this company, I realized that even though at first I focused on nurse-to-nurse, I thought, what about the leaders? Nobody’s teaching the leaders how to address this. I, myself, was in a front line leadership role, and I only lasted 14 months. I had never dealt with such obnoxious behaviors in my entire life. I had never seen professionals behave this way, and I had no idea how to handle it. After I quit, I felt like a failure. I decided as I got older and wiser, I wasn’t a failure. I just wasn’t equipped. I had no idea how to address these behaviors.
I started shifting my focus to helping those frontline leaders. First of all, people think that when you’re in a leadership role, you should intuitively know how to handle employee unprofessional behaviors. We teach leaders how to do the budget, the staffing, payroll, but not all know how to tell their best nurse that she’s toxic. It really starts by heightening awareness of disruptive behaviors. You can’t expect people to change their behavior if they don’t know their behavior needs to be changed. Leaders need to have honest and respectful conversations with their employees.
It’s about setting behavioral expectations. You get together with your team, and you say, how do we always want to be treated? How do we never want to be treated? And then you help your team by learning the skills that they need to be able to do that. What we’re looking at here is culture change.
SB: It sounds a lot like there’s a focus on communication and leadership.
SB: Similarly, BSN programs focus on communication and leadership. Same as a specialized MSN, Healthcare-focused Ed.D., and DNP, among other degree programs. Do you believe that higher education or continued education can lead to improvements when it comes to bullying?
RT: Definitely! People say to me all the time, how did I learn everything that I know now? Was there a program that I went through? I have to say it wasn’t any one thing. First of all, I’ve always studied human behavior. I’ve always been fascinated by it. I minored in psychology when I was in school. But I started as an associate’s degree nurse, and it took me eight years before I went back and got my bachelor’s, and then I got my masters, and then I got my DNP. And with every program, and actually, it was every course, it helped me to become a more well rounded, well-read individual. I remember taking a sociology class and like, ah, why do I want to take sociology? It transformed me as a human being.
Once you’re on that path of continuous learning, every class, every program, every article you read has the potential of helping you to show up as a better human being. I’m a huge advocate for continued education, formal and informal.
SB: Tell me a little bit more about some of the education courses that you offer at the Healthy Workforce Institute.
RT: Well, when the institute was founded, one of my primary strategies was to take what I teach in, say a workshop, and turn it into an online program. We launched the Healthy Workforce Academy a couple of years ago and launched our foundational course for healthcare leaders called Eradicating Bullying & Incivility. Its five content modules. Each student gets a coaching call with me, and we do live Q&A calls every other week. It doesn’t matter if they were enrolled two years ago; they still have access to it.
We just interviewed somebody on my team; his name is Dr. Mitch Kusy. He’s my expert on dealing with disruptive physicians. So we did this interview-style with him where people submitted questions ahead of time, and it was probably one of the most robust sessions that we’ve had. That’s one of our courses.
We also have one now called The Department Culture Change Initiative. It’s the next step. It’s for leaders who want to do a deeper dive and transform their culture, such as how to confront others and set behavioral expectations. How to hold people accountable. Then we go deeper. And we have a couple of other courses that are complementary to that. We’re growing and adding courses all the time.
SB: Wonderful. My last question is, do you have any words of encouragement for someone who might be on the receiving end of nurse bullying?
RT: Yes. First of all, it’s not normal. It’s not okay. It shouldn’t be something where you just accept it as the norm no matter what anybody tells you, and there are some things that you can do about it. Sometimes it’s just speaking up and letting somebody else know that you’re going through this. That alone can be very cathartic. Sometimes you may not feel comfortable going to anybody in your department. Instead, go to an educator. Go to somebody outside of your department who you can confide in that doesn’t directly report to a manager, or it isn’t somebody that you work with.
Know that it’s not like that everywhere. There are outstanding nurses out there that are kind and compassionate towards each other. I have worked with some amazing nurses who will go out of their way to support their coworkers. So, it’s not like this everywhere. Find a better place.