Bullying, or even subtler forms of interpersonal conflict, can be common in any kind of workplace. But it’s particularly corrosive, and dangerous, in healthcare settings, where effective teamwork really can make the difference between life and death.
See this editorial by Theresa Brown, for the NY Times: Physician, Heel Thyself
…while most doctors clearly respect their colleagues on the nursing staff, every nurse knows at least one, if not many, who don’t.
Indeed, every nurse has a story like mine, and most of us have several. A nurse I know, attempting to clarify an order, was told, “When you have ‘M.D.’ after your name, then you can talk to me.” A doctor dismissed another’s complaint by simply saying, “I’m important.”
Of course, as Brown recognizes, the issue is much more complex than simply ‘MD vs RN.’
…because doctors are at the top of the food chain, the bad behavior of even a few of them can set a corrosive tone for the whole organization. Nurses in turn bully other nurses, attending physicians bully doctors-in-training, and experienced nurses sometimes bully the newest doctors.
But even this puts too much emphasis on the behaviour of doctors; I strongly suspect that nurses (and other professionals) are perfectly capable of bullying (or “eating their own young”) even without MDs setting a negative example. The bullying that goes on within nursing (and among different parts of the nursing profession, broadly understood, including between RNs, NPs, LPNs, etc.) is just as important as the bulling that goes on between MDs and RNs.
The hardest questions I’ve ever been asked by med students and nursing students have to do with bullying, and with the difficulties inherent in being at the bottom of their respective professional hierarchies. Students understandably find it difficult — and a source of moral distress — to be not only subject to bullying, but to sometimes be involved in courses of action that they see as unethical and yet powerless to do anything about it. It’s hard to know what to tell them, because sometimes there really is very little they can do. But one thing they can do, I tell them, is to consider, starting right now, how they think they should treat those beneath them in the hierarchy, once they inevitably move up it, and how they are going to make sure they don’t fall into those all-too-common toxic behaviours.
The Nursing Ethics Blog 
You have posed some interesting questions here. Of course, everyone has to take 100% responsibility for their behaviour and their reactions to other people’s bad or good behaviour. Trouble is, those on the bottom of the ‘food chain’ have a harder time of doing just that than those at the top. Every profession has to take a good hard look at itself and think about how it teaches the newest members of the profession, how they are supported and what is the culture that is being engendered. My dissertation was on doctor and midwife interactions in the care of birtthing women. I found that when policies, procedures and a ‘medical model’ were operational, everyone behaved robotically and fell into stereotypical behaviours, no matter how socially and emotionally intelligent they usually were. No one felt good. Conversely, when the woman (aka patient) was a co-equal member of a round table approach and the needs of the woman (aka patient) were of paramount importance, every one behaved in intelligent ways and all felt good about the outcomes.
Here’s the link to the disseration for those who are interested
http://hdl.handle.net/1959.13/29305
I’ve also written an article on exploring horizontal violence/ workplace bullying
http://uts.academia.edu/CarolynHastie/Papers/497411/Exploring_Horizontal_Violence
Organisational structures need to change so that people can become and behave in more emotionally and socially intelligent ways. The people we serve will do much better when that happens. We will also enjoy our work so much more as well.
I am an RN and until last Oct. was employed at a max security prison in WI. I was bullied by some co-workers, of which my manager and district manager were both aware as I had discussed these issues with both of them multiple times. Both told me to “hang in there, it will get better”. Well, it never did. And when I filed a complaint, including how my patient care and patient appointments were being sabotaged by these individuals, instead of any help, I was fired. I had documentation of the individuals actions, names, dates, incidences. To top it off, my managers never interevened on my behalf and denied ever having had any discussions with me. One of them even witnessed one persons screaming and ranting at me and did nothing. Both managers stood back and let administration fire me.
Since my complaint involved patient care and in effect, denying those patients(inmates) adequate care, I pursued my complaint and illegal firing with the Dept of Labor under whisleblower protection statutes. Now I get to sit and wait while things s-l-o-w-l-y are assessed by the Dept of Labor, etc.
The emotional trauma from all this caused me to self harm and I had to go into treatment with a counselor and psychiatrist.
I am presently working, making $7.00 an hour less, no benefits, no insurance, had to stop seeing the doctors. This is terribly stressful. I am seeing a wonderful man who supports me alot but I still have alot of issues to deal with.
In addition, they fired me the same day my husband passed away. Lots of stress, self doubts, anger, confusion…
So much for asking my boss for help; that will never happen again. And forget advocating for my patients; I just go to work, do what I have to and get out of there. I will not speak up again, if I even stay in nursing. Right now it pays the bills, but the pleasure and self esteem I had before are gone. It is a poisonous field of work with poisonous people.
Bullying is getting more and more common in workplace, the power the manager had is too much. The hardest part is that even you know that you are treated unfairly there are nothing much you can do, because some hidden bullying is hard to prove. Most of the time the bullies know how to bully you and not get in to trouble by doing so. Another thing I had seen in nursing is that nurses rarely stood up for another nurse because they don’t want to be the next target. With no peer support you cannot do much against the bullies especially when that is your manager or charge nurse. So you think you can ask the union to help, but no since bullying is not violating the collective agreement. I had experienced being bullied, it was obvious but I was not able to proof it and had to stick it out until the manger leaves. It caused so much unhappiness and my life was miserable, going to work was like going to a jail. It affects my health, my social life and personal relationship. Making matter worse even though I was qualified to get job and many job was offered, the manager decided to not to give me a reference, so all the 5 years I spend at that place would have gone unnoticed, no choice just stay at the miserable job thinking only about paycheck and waited until she was transferred.
Hi thanks so much for a very interesting article. As a registered nurse I think it is very important that we understand where nurse bullying comes from and why it continues to flourish in our healthcare systems.
http://critcare-reflectionsofamalenurse.blogspot.com/2011/09/hospital-corners-origins-of-nursing.html