Workplace bullying contributes to decreased team cohesion, burnout, retention issues, and absenteeism. This article will help managers and other nurses influence policy development with suggestions on crafting usable and effective anti-bullying policies.
Workplace bullying, incivility, and disruptive behaviors are related actions threatening the safety culture in healthcare organizations.1-3 These behaviors also contribute to decreased team cohesion, burnout, retention issues, and absenteeism.4-7 In 2008, The Joint Commission issued Sentinel Event Alert 40, Behaviors that Undermine a Culture of Safety, a document that requires accredited healthcare organizations to establish policies that address disruptive behaviors, such as workplace bullying and incivility.
Despite this directive, many nurse managers and clinical nurses report that their organizations don't have the required policies, that they aren't widely disseminated and are virtually ignored, and that they're often unclear and difficult to use in practice.8,9 The goal of this article is to provide managers and other nurses with the opportunity to influence policy development with suggestions, which come from research and practice, on how to craft usable and effective anti-bullying policies.
Differentiating the disruptive
Workplace bullying, harassment, and general incivility can manifest similarly. Although all of these behaviors are undesirable workplace behaviors, managers recognize that they need to be managed differently.10 It's important to understand the differences between workplace bullying, incivility, and harassment, all of which fall under the category of disruptive behaviors, and how to manage each.
Workplace bullying consists of frequent (daily, weekly, or monthly) and persistent (lasting for several months or years) harassing and intimidating behaviors. Common bullying behaviors fall into the categories of physical bullying, social bullying, and work-related bullying. These behaviors may be subtle, and individually may seem relatively innocuous. However, due to the recurrent nature of workplace bullying, it can be classified as a chronic occupational stressor. As a result, victims of bullying are more likely to suffer negative health effects such as frequent headaches, gastro-intestinal (GI) upset, severe anxiety, depression, and symptoms of posttraumatic stress disorder than their nonbullied peers.11
One of the reasons that workplace bullying behaviors persist over a long period of time is that the bully has more power (either positional, having more institutional knowledge, or more social support in the workplace) than the victim. This power differential creates a situation wherein victims of bullying are generally unable to end bullying by merely confronting the perpetrator.12 Likewise, the power differential means that the perpetrator of bullying has no motivation to end the behavior (other than possible fear of disciplinary action). Therefore, conflict resolution and mediation, which require compromise from both parties, have been found to be ineffective strategies for ending ongoing bullying.13 It's important that workplace policies recognize this fact and don't include language that requires victims of bullying to confront perpetrators, or to engage in unfruitful mediation.
Incivility, which can be confused with bullying, is characterized by low-intensity rude and discourteous behaviors.14 These behaviors occur occasionally, and don't cause long-term distress. Incivility, which is often unintentional, can generally be dealt with by bringing the behaviors to the attention of the perpetrator, by conflict resolution or by mediation. Organizations and individual departments can prevent incivility by establishing and reinforcing a code of conduct, a document which delineates norms of healthy behaviors.
Harassment may also look like workplace bullying. However, harassment is a legally defined term that covers unwelcome and offensive conduct that's based on the recipient's race, color, religion, gender, national origin, age (40 or older), disability, or genetic information. In contrast, there are no legal definitions or laws that address workplace bullying. All organizations should have anti-harassment policies, however, legally speaking, they don't cover bullying or incivility that's not based on an employee's legally protected class (for example, behaviors that occur between women).15 Therefore, it's important that organizations also have a document specifically addressing workplace bullying.
Brainstorming effective policies
When drafting workplace bullying policies, it's important to include representatives from the various groups who will be affected by the policies. This includes human resources, unit-level managers, representatives from employee health, and employees. Make sure to get buy-in from unions or at least allow them an opportunity to comment on policies; managers often cite union grievances as one of the obstacles to successfully disciplining perpetrators of bullying behaviors.8 By including the stakeholders and end-users, organizations will ensure that they have policies that are clearly understood and easy to use. Additionally, members of the organization who helped draft policies can be instrumental in ensuring that these policies are widely disseminated and enforced.
Successful policies are clear and concise, and contain the following elements: an introduction, an outline of the roles and responsibilities of organizational members in workplace bullying management, and the actions that employees and managers can take in response to workplace bullying.
Drafting the strategy
Policies should begin with a brief introduction to the problem of workplace bullying, and why it needs to be addressed. Because bullying behaviors have historically been ignored in most workplaces, it's important to underscore that these behaviors aren't acceptable. The introduction should include statements that these behaviors can negatively impact the health of workers, the safety of patients, and the efficient operation of the organization.
The introduction should then define workplace bullying and give examples of bullying-type behaviors. In the introduction, organizations can also make it clear that not all rude or uncivil behaviors rise to the level of bullying. In addition, the policy might contain language differentiating legitimate and fair management of employees and workplace bullying.
Organizational roles and responsibilities
The next section should list the roles and responsibilities of staff, managers, human resources, and employee health as they relate to workplace bullying. Although employee health hasn't traditionally been included in workplace bullying policies, it's important to include this department because workplace bullying can have negative effects on employee's health and well-being.
When drafting staff roles and responsibilities, organizations need to be aware that one of the elements that differentiates workplace bullying from incivility or workplace conflict is that targets of bullying don't have the leverage needed to get the perpetrator to end the behaviors.16 Therefore, language that requires targets of bullying to confront perpetrators is inadvisable. Instead, policies need to clearly delineate the actions that targets may take to enlist the help of others. On the other hand, employees who aren't targets of bullying, but are aware that it's occurring, may be able to confront the perpetrator; and this group of employees shouldn't be forgotten when drafting policies.
Formal and informal responses
The final section of the policy should contain suggestions for formal and informal actions that managers can take if workplace bullying does occur. Although stating that the organization has zero tolerance for bullying is tempting, such a statement isn't useful in practice because it doesn't clearly state the consequences for these behaviors. Even with zero tolerance policies, organizations that are unionized can't summarily dismiss perpetrators of bullying. Furthermore, merely dismissing perpetrators of bullying may result in the loss of valued employees who can learn to change their behaviors or employees who've been wrongfully accused.
If managers catch workplace bullying before it has occurred for a long period of time, they may be able to successfully resolve it through conflict resolution or mediation. These actions are only appropriate in early stages of the conflict, and, as previously stated, haven't been found helpful for bullying that's ongoing.16 Because managers often lack the time or skill to engage in mediation or conflict resolution, organizations should consider using a neutral third party, such as an ombudsperson (a person who serves as a neutral facilitator for conflict resolution and problem solving) to assist in this capacity. If conflict resolution or mediation is undertaken, managers need to frequently touch base with the victims of bullying to make sure that the behaviors have stopped. If perpetrators continue to engage in bullying after informal processes have begun, formal disciplinary processes should be initiated.
Formal responses to bullying include disciplinary measures such as a performance plan and progressive guidance. To make sure they're following the proper procedures, and can successfully defend their actions if there's a grievance, managers should be encouraged to consult with human resources if they need to initiate formal action. Performance plans and progressive guidance should include clear expectations for immediate behavior change. If perpetrators of bullying behave well for a period of time, then revert to their previous behaviors, managers should be able to reinstate progressive guidance at the same, or higher, level and shouldn't be required to start the process all over again. This will prevent situations wherein perpetrators behave well for a while, then revert to their former behaviors as soon as they graduate from their performance plan.8
Codes of conduct
Some organizations, or individual units, may wish to issue a code of conduct in addition to a policy that addresses bullying. Codes of conduct can be used to address incivility, disruptive behaviors, or mere rudeness. A code of conduct might consist of a list of desirable or positive behaviors, or may be a single sentence that states employees have a right to be treated with dignity and respect. For instance: All employees of this organization have the right to be treated fairly, with dignity and respect.
If organizations don't want to draft more than one policy, elements of a code of conduct or dignity policy can be incorporated into the anti-bullying policy. Codes of conduct can help managers and staff discuss desirable behaviors, set norms for workplace interactions, and prevent bullying from occurring. Some units ask members to sign a statement indicating that they'll abide by the code of conduct, and post this code in a prominent place.
Policies are only effective if members of the organization are aware of them, actively discuss them, and utilize them. Support for policies needs to come from all levels of administration. Education regarding policies, particularly those that address behaviors, needs to recur frequently. Behavior change takes time, and requires constant reinforcement. Open acknowledgement of the existence of these policies isn't an announcement that the organization is dysfunctional. On the contrary, it indicates to current and prospective employees that the organization is serious about establishing and maintaining an open, professional, and collegial workplace where all employees are treated with dignity.
Dignity for all
Workplace bullying is a pervasive problem for the healthcare industry. It's important that healthcare organizations have well-written policies that can be used by managers and employees to respond to bullying. After being written, policies need to be periodically revised with input from the end users. Anti-bullying policies are important documents that will help organizations function at their highest capacity to provide excellent patient care and customer service.
Adapted from “Create effective anti-bullying policies” by Susan L. Johnson, PhD, RN. This article originally appeared in the May 2015 issue of Nursing Management © 2015 Wolters Kluwer Health.
- Rosenstein AH, O'Daniel M. Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nurs. 2005;105(1):54–64.
- Laschinger HK. Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. J Nurs Adm. 2014;44(5):284–290.
- Wright W, Khatri N. Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Manage Rev. 2015;40(2):139–147.
- Baillien E, Neyens I, De Witte H, De Cuyper N. A qualitative study on the development of workplace bullying: towards a three way model. J Comm Applied Social Psych. 2009;19(1):1–16.
- Laschinger HK, Grau AL, Finegan J, Wilk P. New graduate nurses' experiences of bullying and burnout in hospital settings. J Adv Nurs. 2010;66(12):2732–2742.
- Johnson SL, Rea RE. Workplace bullying: concerns for nurse leaders. J Nurs Adm. 2009;39(2):84–90.
- Alterman T, Luckhaupt SE, Dahlhamer JM, Ward BW, Calvert GM. Job insecurity, work-family imbalance, and hostile work environment: prevalence data from the 2010 national health interview survey. Am J Ind Med. 2013;56(6):660–669.
- Johnson SL. An exploration of discourses of workplace bullying of organizations, regulatory agencies and hospital nursing unit managers [Ph.D. dissertation]. University of Washington; 2013.
- Sellers KF, Millenbach L, Ward K, Scribani M. The degree of horizontal violence in RNs practicing in New York State. J Nurs Adm. 2012;42(10):483–487.
- Johnson SL, Boutain DM, Tsai JH, Beaton R, de Castro AB. An exploration of managers' discourses of workplace bullying. Nurs Forum. 2015; epub ahead of print.
- Nielsen MB, Einarsen S. Outcomes of exposure to workplace bullying: a meta-analytic review. Work Stress. 2012;26(4):309–332.
- Einarsen S, Hoel H, Zapf D, Cooper CL. Bullying and Harassment in the Workplace: Developments in Theory, Research, and Practice. 2nd ed. New York: CRC Press; 2011.
- McColloch B. Dealing with bullying behaviours in the workplace: what works—a practioner's perseptive. J Int Ombudsman Assoc. 2010;3(1):39–51.
- Pearson CM, Andersson LM, Porath CL. Workplace incivility. In: Fox S, Spector PE, eds. Counterproductive Work Behavior Investigations of Actors and Targets. Washington, DC: American Psychological Association; 2005:177–200.
- Yamada D. The phenomenon of “workplace bullying” and the need for status-blind hostile work environment protection. Georgetown Law J. 2000;88:475–536.
- Keashly L, Nowell BL. Conflict, conflict resolution, and bullying. In: S Einarsen, H Hoel, D Zapf, CL Cooper, eds. Bullying and Harassment in the Workplace: Developments in Theory, Research, and Practice. 2nd ed. New York: CRC Press; 2011:423–445.