Bosses, Bullying & Burnout in Nursing

A negative work environment impacts the hospital’s bottom line. With an estimated cost of $65,000 to replace each burned out nurse, lowering the turnover rate among novice nurses is a critical business goal.1

One of the major factors behind nurse turnover is bullying. 60% of new nurses left their first job within six months of hire because of bullying.2

“It’s very disheartening when new nurses enter the profession and are eaten alive,” remarked Rebecca Saxton, PhD, RN, CNOR, CNE, associate professor at the Research College of Nursing in Kansas City, MO.

Peggy Berry, PhD(c), MSN, RN, University of Cincinnati College of Nursing, said, “There are many root causes as to why workplace bullying occurs.”

Berry recently gave a presentation, “The Effects of Workplace Bullying on the Productivity of Novice Nurses.” She defined bullying as “direct or indirect aggressive acts that attack the worker or the work.”

Bullying by the Numbers

According to Berry, some of the more common root causes include personality clashes, territorial clashes, and the urge to mold new nurses into the group norm.

“Some people are different and they all need to learn how to work together,” she explained. “In some instances they do not and it causes problems.”

Berry and her co-authors cited an earlier survey reporting 30% of nurses wanted to leave their current job because of bullying. In their own survey of 197 novice nurses:

  • 55.3% were never bullied at work

  • 26.4% were rarely bullied at work

  • 16.2% were bullied now and again

  • 2% were bullied several times per week3

Nurse leaders and staff nurses caused the greatest number of bullying incidents, more so than physicians and other clinical personnel.

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More than 50% of nurses surveyed by ANA had been threatened or verbally abused at work.

While the percentage of nurses who reported being bullied several times a week was the lowest, that group felt the impact the greatest. They reported a 25% drop in their productivity levels. Berry explained that the drop especially increased when the bully was in a position of power rather than a peer.

Wendy Budin, PhD, RN-BC, FAAN, director of nursing research, NYU Langone Medical Center, examined bullying on a larger scale in a study of 1328 nurses. Budin’s survey only looked at peer-to-peer bullying; not supervisor-to-peer.

Verbal abuse was the most commonly reported disruptive behavior, with 49% of survey participants reporting having been verbally abused at least once in the past three months. Participants defined verbal abuse as being spoken to in a condescending manner or being ignored, having conversation controlled or refusing to comment. 4

In Budin’s study, the higher the levels of verbal abuse, the lower the levels of job satisfaction, commitment to the organization, autonomy, and intent to stay. She cautioned, however, that it’s unclear if poor working conditions foster an environment where bullying is acceptable; or if it’s the bullying itself that creates the hostile environment.

Burned Out Newbies

Berry followed up with the nurses from her survey, 18 months later.

According to her, within three years, 27% of novice nurses leave their original facility. 1/3 of those departures are directly caused by bullying behaviors.

She noted, “Nurses can get burned out when they constantly have to work around not having help.”

“Orienting into a new facility is stressful and can increase anxiety,” Berry admitted.

She recommends hospitals bring new hires in for focus groups to discuss issues in a safe environment

“It helps them to understand that lateral and horizontal violence are bullying,” Berry said.

Budin also encouraged hospital-wide programs to teach employees about the effects of verbal abuse.

Saxton concurred. She introduced Crucial Conversations training to the AORN-Greater Kansas City Chapter.

Nurses need to be able call disruptive behavior out as bullying. “You can’t be a good clinician unless you’re an effective communicator,” Saxton said, adding facilities need to give nurses the tools and support to confront bullies, increasing their confidence to address negative behavior.

“It’s time and money well spent to create healthy work environments,” Saxton said. “When people like where they work, they are more likely to stay.” She believes all hospitals need to instate policies and procedures to address bullying.

The onus to stop disruptive behavior must be shared. Dina A. Faucher, PhD, MSN, RN, OCN, Regional Nursing and Health Professions Director at Everest College, Las Vegas, observed, “It’s everyone’s responsibility to stop it from occurring. Leaders can’t be everyone at once.”

In addition to technical skills, novice nurses need teamwork and support to succeed. Yet, Everest College graduates often report they are amazed at the lack of support they receive in their first jobs. “The statistics of nurses who leave their jobs are astounding,” noted Faucher.

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Stopping the Flood

One facility that took steps to address turnover among new nurses, whether it relates to bullying or another cause, is Miami Valley Hospital in Dayton, Ohio.

“Our Center of Nursing Excellence directed by Jayne Gmeiner MS, RN, NEA-BC, really works closely with our new nurses during the first year,” said Pat O’Malley, PhD, RN, CNS.

O’Malley, Gmeiner and colleagues Brenda Barnes, MS, RN, Anitra Martin MS, RN, and Mary Pat Thomas MS, RN, AHN-BC, research concluded that between one-quarter and two-thirds of novice nurses will leave their first position with a year of hire.

They found that the nursing shortage is expected to increase 2% to 3% annually. Nationally, the turnover rate is approximately 20%.

Miami Valley started a mandatory program for its new nurses, Bridge to Practice. The program has trained almost 700 new hires in nursing resilience over the past five years.

 

The theory behind Bridge to Practice is that by addressing the root issues they can tackle the greater problem of bullying, imposter syndrome, incivility, moral distress and communication. “We’re very strong in communication skills training and helping our new graduates to adopt a mindset of self-care and safety which helps reduce turnover,” said O’Malley.

New nurses attend confidential group sessions two months and five months after hire; additionally, they also participate in written self-assessment. During these sessions, nurse learn about coping strategies and best practices to deal with issues related to work-life balance; new grad stresses; critical thinking; crisis management; lateral violence; nursing ethics; self-care; and numerous other topics dealing with professionalism.

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Bridge to Practice has been a success. Since it began in 2008, the annual nurse turnover rate at Miami Valley has dropped to 11%. 97% of participants thought the program helped them develop better resiliency.

When asked what was most helpful, one attendee remarked, “Ways to cope with stress and knowing that what I’m feeling is normal and shared with my fellow nurses.” Another employee cited, “Sharing stories with people who understand and can relate,” as the most useful aspect. 5

Although there are Joint Commission guidelines on workplace bullying, they were written initially to address the physician-nurse relationship, not the nurse-nurse relationship. Berry said, “We still have a long way to go in controlling what we as nurses do to each other.

“We can’t be silent about the time, tools and support that we need in order to do our jobs right.” Nurses should promote a safe working environment for all healthcare personnel.

References for this article can be accessed here.

Danielle Bullen is on staff at ADVANCE. Contact dbullen@advanceweb.com.

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