Workplace Health Portfolio

Provide a rationale for choosing this theme, and provide a definition and clear explanation of the selected theme using relevant references

This study will focus on the stress experienced by health practitioners as a result of bullying in their workplaces either by senior personnel or co-workers. Bullying has previously been only thought to affects children, more so school going children. It is only in the past two decades that sufficient research has been done to show that workplaces have been a breeding ground for bullying especially from people at higher power levels in the organization (Khan and Khan, 2012).

Workplace bullying according to Blackwood, Bentley, Catley and Edwards (2017) is defined as any disruptive and inappropriate behaviour in the workplace demonstrated by one employee to another who is in a position of equal, higher or lower rank. Workplace bullying is also often referred to as lateral violence or horizontal violence. Nursing is said to be the primary occupation at risk for lateral violence affecting 44-85% of all nurses while 93% of the nurses reported witnessing or being victims of bullying. Incivility in the workplace can be characterized by rude or condescending behaviour towards fellow health workers,

Johnson and Rea (2009) state that the main perpetrators of nurse bullying as reported by half (50%) of nurses who reported bullying in the workplace was done by directors, co-worker bullying being second with 38% and charge nurses being third at 25%. The increased cases of nurse bullying has however increased over the years with more recent studies conducted by Berry et al. (2012) showing increased bullying by senior nurses, accounting for 63% of all cases, staff nurses stood at 44% and a significant drop in bullying cases to 19% in those in leadership positions such as directors and managers. Dewitty et al. (2009) point out that new hires and graduates are the group most vulnerable to bullying since they the confidence to resist and lack solid friendships to shield them from the bullies. They further state that intelligent, competent and accomplished people who tend to have new ideas that may challenge current systems are bound to be victims of bullying as they may eventually be a threat to someone at higher positions whose position might be in jeopardy because of the new hires and graduates with fresher ideas.

The effects of bullying in the nursing profession carry over to both the organization and patient as well. Rodriguez et al. (2009) reports the negative impacts of bullying on nurses. These include reported cases of depression, anxiety, fatigue, terrible sleeping patterns and increased drug use, either in the form of tobacco or alcohol. A recent study conducted in 2012 by Workplace bullying Institute showed a significant number of victims contemplated or had a plan in place to commit suicide. 29% of nurses surveyed had thought of suicide while 16% already have an action plan to actually go through with it. With such high levels of stress experienced by nurses due to bullying, safety of patients in their care should be under scrutiny. Bullying, according to Berry et al. (2012), leads to loss of professionalism and commitment towards patients leading to compromised patient care as the nurses are unwilling to ask questions regarding what procedures or equipment they are unfamiliar with, especially if placed with their bullies. Workplace Bullying Institute (2012) also documented the link between nurse bullying and patient mortality. Nurses in poor environments characterized by bullying increased the odds of patient death and their inability to rescue them. The hospital management is also greatly impacted due to bullying within the organization as absenteeism cases rise, high turnover of employees and patient safety at risk. Employees are more likely to leave organizations where they feel unsafe to more professional ones. The hospital also has the financial burden to bear the cost of high staff turnover which might cost between $92000 and $145000 just to replace one nurse (Johnson and Rea, 2009). The cost of bullying is also carried forward in carrying out the investigation as well as lost work days by nurses taking days off due to stress caused by experiencing hostile work conditions.

Address the following questions:

How does the organisation currently approach and manage this issue within the specified workplace?

What are the strengths and weakness of the current approach and management of the issue? – provide examples & evidence

Identify the relevant health and workplace legislation and policy related to this issue and discuss how the specific workplace has responded to key legislation and policy

Identify 3-4 areas of delivery where the current approach could be improved – provide a rationale and evidence

The current approaches taken by hospitals management to deal with bullying of nurses include:

Creating channels for employees to be able to report to management of witnessing or being victims of bullying.

Process complaints fairly with a standard investigation process with universal discipline policy with caution not to make exceptions based on position of the alleged bully in the organization.

Implement trainings in institution to educate staff on types of bullying, the effects and repercussions they could face if found doing so.

Review current policies and procedures especially if bullying cases are still being reported even after implementation of policies and laws against it.

The above measures put in place by hospital management to curb issues have demonstrated success in that cases of bullying in affected organizations have been reported to significantly reduce. Low incivility cases have shown to provide a good workplace environment that can motivate employees to be more productive, better patient care and improved employee health (Sarik et al.,2020).

Few turnovers of staff in the hospitals have improved leading to less money spent on new employee hiring and replacement. Less money is spent on hiring and training firms to source new eligible nurses, hiring incentives and lost production cost that have to be made up for by other workers (Peters et al., 2020).

The set policies and rules to govern incivility cases are clearly laid out to show the consequence of each action. The policies create standard punishments and disciplinary actions to be taken making no exception to ones’ status in the organization. Every employee is held to the same standard (Rocker, 2008).

Hospital approaches to counter incivility amongst employees have also met some weaknesses in terms of stigmatization of victims and/or bullies, cost, time and probability of false reporting. Bullying victims may face stigma from fellow co-workers as they are seen as whistle-blowers. This is bound to intimidate other victims from reporting future cases for fear of being alienated within the organization. In implementing training for their staff on how to handle incivility, hospitals incur the cost of paying the workers for the time they take off to attend the training as well as the cost of hiring trainers for that activity (Ametz et al., 2019). This is money that would have been set aside for much better use to improve healthcare. Time also has to be allocated to deal with reported cases, attend trainings and conduct investigations in hospitals. In such a busy and critical environment, time is of the essence as patient care is of utmost importance.

Most European countries such as Sweden and France were amongst the first to enact laws against victimization at work. These laws put an obligation to employers to prevent psychological harassment of their employees. In areas where bills are present but not enacted into law, organizations are being encouraged to use the bills as a framework to develop their own policies which they can easily adjust to fit the organizations’ needs. Majority of hospital managements are implementing anti-bullying policy statements by;

Clearly defining what bullying is

Elaborating what actions can be classified as bullying

Training of managers and supervisors to identify cases of bullying

Setting up communication and investigative channels where staff can easily lodge their complaints on bullying and harassment and expect investigations to be carried out

Coming up with recommendations on how to deal with incivility cases in the hospital

The current approaches taken by hospitals despite being effective leave room for improvement. Nurses have been encouraged to report any cases of bullying either being victims or witnesses of the act. However, reporting to management exposes the reporters to be stigmatised even more especially if the alleged bully has been in the organization longer and therefore has more friends or is close to members of the Human Resource Department (Hampton, Tharp-Barrie and Kay, 2019). This might discourage victims as they feel alone and ganged upon. Hospitals should ease communication channels between staff and management to encourage easy reporting to other people in power if victims of incivility feel they cannot approach the set reporting channels.

Enforcing frequent training for employees is not a guarantee that bullying cases will decrease. Rocker (2008) advises that hospital management must ensure that they do follow up tests and questionnaires to the staff to get feedback on the impact of the training conducted. Reminders and alerts can also be sent often to employees’ phones either via email or text messages to keep them in constant check on how to treat their co-workers.

Policies and legislations within the hospital settings should be reviewed often especially if the current ones set do not seem to work. An increase of bullying cases after policies have been put in place is an indicator that the staff did not understand the laws or current laws is not tight enough. Reforming these policies together with the employees or their representative to stricter laws that may include pressing charges or terminating employment of the perpetrators (Edmonson and Zelonka, 2019).

Internal investigation may be biased whenever the perpetrator is in a position of power or has a certain influence over people. Investigations can be carried out by either a different department to prevent bias or the management can outsource external bodies to carry out investigations that they have been unable to handle on their own (Rocker,2008). Outsourcing ensures unbiased results as the external body is not affiliated to any of the victims or perpetrators.

Discuss exactly how this improvement could be achieved using relevant up to date evidence

Stigmatization of victims after reporting has been made can be rectified by improving the reporting channels by providing toll free numbers, setting up suggestion or complaint boxes around the hospital and encouraging anonymous reporting. Whistle-blower programmes should be made anonymous and all employees, both existing and new, should be aware of the program. These programmes can come as a mobile app or software for the organization (Rocker, 2008). The programs should provide anonymity of the reporter by not asking about information that can be used to identify them such as email addresses, phone number and work ID. Hospitals should encourage their staff and build their confidence by explaining to them the steps they will take to ensure their anonymity when reporting and how the results can be used to improve bullying incidents (Ametz et al., 2019). An example of such a mobile apps is STOPit and SAFE reports which is a management tool that handles anonymous reporting via both mobile and desktop.

Discuss exactly how this improvement could be achieved using relevant up to date evidence

Conducting anti-bullying training, compensating affected victims and loss of manpower are all costs covered by an organization and might interfere with its financial responsibility. These costs incurred can however be minimized by conducting in house trainings as opposed to outsourcing trainers. With technology, there are a variety of free materials that can be easily accessed by employees; these can be posted in hospital websites or shared to individual employee emails (Hampton, Tharp-Barie and Kay, 2019). The persons involved in the bullying fiasco should also be encouraged to sort out their issues face to face in the presence of mediators to prevent court cases or organizations’ interference. Talking out ensures that the alleged bully is made aware of their actions and how the victim perceived these actions. Dewitty et al. (2009) suggest that when no changes in the perpetrators’ actions are noted, the organization can then interfere with disciplining the bullies.

Discuss exactly how this improvement could be achieved using relevant up to date evidence

Time is of essence in the medical field and patients’ lives may be at risk when focus is on workplace bullying. Most of the time wasted in conducting trainings, looking for new employees for departed victims, disciplining bullies and counselling victims could be better used in service delivery. Time saving techniques like Just In Time training (JIT) can be executed to minimize time normally spent on training. Trainings can leave work spaces unmanned contributing to poor service delivery to patients. JIT ensures the necessary courses and information can be accessed anytime and anywhere more so to nurses who do not have much time to spend on their computers. This system can be used over lunch hours as it is easily accessible on mobile phones. With the limited time available to access relevant information, JIT ensures that the course content is short but filled with relevant information (Khan and Khan, 2012).

Discuss exactly how this improvement could be achieved using relevant up to date evidence

False reporting of bullying cases is not to be overlooked by organizations where bullying cases are on the rise. Necessary caution has to be applied to avoid people reporting falsely due to malicious intentions. In hospitals, managers and supervisors are more at risk of being the subjects of false claims on bullying. They may be reluctant to call out the bullies as they feel it reflects their inability to perform their responsibilities (Sarik et al.,2020). A false claim of bullying in the health sector often comes from underperforming staff that may gang up against a supervisor. Persons unfairly accused have to deal with the long investigation and disciplinary process, risking damage to their reputation which may cause them to feel hurt, frustrated and increase anxiety.

Organizations should therefore support persons accused of bullying during the filing of the complaint as well as during the investigation process. Peters et al. (2020) suggest that the accused persons should not be punished or alienated until investigations are completed and the reports substantiated. Workplace policies, procedures and guidelines should be put in place and engaged when unsubstantiated cases of bullying are reported to prevent further occurrences of false reporting. Wrongful reporting should lead to serious disciplinary action which may lead to employment termination.

How could the suggested Improvements be evaluated within the next 6 months?

Evaluation plan for improvement 1

Stigmatization of nurses who report being bullies can be evaluated by managers noting interactions between the victim and other members of staff. The manager should be able to tell if the victim is coping better in terms of overall appearance, mood and interaction with patients. Service delivery from victims will also be an indicator if the bullying issue has been well handled. After the six months the supervising nurse should be able to tell if the victim grown professionally. The nurse should also be interviewed or if an anonymous report was made, issued questionnaires to correctly determine if he/she feels safer in the work environment.

Data on reoffending persons should be made analysed to see employees who are repeat offenders. Knowledge on laws and policies can only be known by the nurses being subjected to tests and/or filling questionnaires. This will ensure the management knows exact areas to focus on and which employees should be on their radar for bullying tendencies.

Evaluation plan for improvement 2

Evaluation of training after 6 months can be done to ensure that the information was well received, understood and implemented to minimize on unnecessary training that is time consuming. The number of cases should be noted to determine if civility is being achieved in the hospital amongst the workers. Tests should be issued to participants of the training to determine if there was information retention as well. The tests can be in form of written tests, questionnaires or oral interviews. Observation by managers and external bodies should be reported to note if there is change in the way staff interact and if there is improved service delivery from nurses who had previously been victims of bullying. This will save on the time and cost of training as only specific sections not well comprehended will be addressed.

Evaluation plan for improvement 3

Cost analysis will be done by comparing the previous cost used in training and the current cost being used by cost saving measures. The difference should be large enough to be an incentive to cut down on training costs. Turnover rates will also determine the financial cost the hospital incurs. Low turnover from solving incivility cases and promoting a safe workplace should be expected. The financial department should be able to tell the cost the hospital has incurred over the 6 months in hiring and training new employees.

Evaluation plan for improvement 4

On the case of false reporting, the investigative body should present reports on new data collected since implementation of more stringent laws. From the data one should be able to tell if the number of bullying cases have increased or reduced. The data should also inform on whether there have been cases of false reporting even after improvements have been made on investigative methods. The data should also inform one of whether there has been a development of new cases in departments where the nurses accused of being bullies have been transferred to. Nurses who are noted to be frequent reporters of false bullying should be addressed and warned of serious actions that might befall them including risk of losing their jobs if they keep up with the practice.

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Conclusion

In conclusion, we can see the psychological impact to nurse of lateral violence in the hospital setting. Bullying affects not only the nurse but also the organization in general as well as patients. The psychological well-being of nurses is important as they are the heart of the hospital. Having depresses, anxious and demoralized nurses working on patients is bound to increase patient mortality due to negligence. Nurses’ welfare should therefore be protected by setting stringent policies against bullying and creating anonymous and direct channels to report any cases of bullying. They should also be assured of protection against retaliation and job losses if they report instances of incivility. Though complete elimination of bullying in the nursing profession will take a while to achieve, hospitals are at least making an effort to ensure proper mental state of their employees by having zero tolerant policies on any bullying cases. Incivility in the nursing profession can be greatly minimized by improving the curriculum taught at school. Current focus is on patient care ignoring nurses’ communication and tolerance amongst themselves. Introducing courses that focus on proper workplace etiquette will definitely improve the way nurses interact with each other.

Writing this portfolio has opened my eyes in seeing workplace bullying as such an underreported occurrence especially in the medical field. Knowing what nurses go through in their personal lives due to bullying but still care for patients has made me hold them in high regard.

References:

Arnetz, J.E., Fitzpatrick, L., Cotten, S.R. and Jodoin, C., 2019. Workplace bullying among nurses: developing a model for intervention. Violence and victims, 34(2), pp.346-362.

Berry, P.A., Gillespie, G.L., Gates, D. and Schafer, J., 2012. Novice nurse productivity following workplace bullying. Journal of nursing scholarship, 44(1), pp.80-87.

Blackwood, K., Bentley, T., Catley, B. and Edwards, M., 2017. Managing workplace bullying experiences in nursing: the impact of the work environment. Public Money & Management, 37(5), pp.349-356.

Dewitty, V.P., Osborne, J.W., Friesen, M.A. and Rosenkranz, A., 2009. Workforce conflict: What's the problem?. Nursing Management, 40(5), pp.31-33.

Edmonson, C. and Zelonka, C., 2019. Our own worst enemies: the nurse bullying epidemic. Nursing administration quarterly, 43(3), p.274.

Hampton, D., Tharp‐Barrie, K. and Kay Rayens, M., 2019. Experience of nursing leaders

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Johnson, S.L. and Rea, R.E., 2009. Workplace bullying: concerns for nurse leaders. JONA: The Journal of Nursing Administration, 39(2), pp.84-90.

Khan, A. and Khan, R., 2012. Understanding and managing workplace bullying. Industrial and Commercial Training.

Peters, A., El-Ghaziri, M., Quinn, B., Simons, S. and Taylor, R., 2020. An exploratory study of bullying exposure among school nurses: prevalence and impact. The Journal of School Nursing, p.1059840519897308.

Rocker, C.F., 2008. Addressing nurse-to-nurse bullying to promote nurse retention. Online Journal of Issues in Nursing, 13(3), p.N_A.

Rodríguez‐Muñoz, A., Moreno‐Jiménez, B., Sanz Vergel, A.I. and Garrosa Hernández, E., 2010. Post‐Traumatic symptoms among victims of workplace bullying: Exploring gender differences and shattered assumptions. Journal of Applied Social Psychology, 40(10), pp.2616-2635.

Sarik, D.A., Thompson, R., Cordo, J., Roldan, I.N. and Gonzalez, J.L., 2020. Good for Nurses, Good for Patients:: Creating a Healthy Work Environment in a Pediatric Acute Care Setting. Nurse Leader, 18(1), pp.30-34.