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After completing this course, the learner will be able to Define in a practical manner bullying, workplace violence, incivility and related terms. Analyze plausible departmental resources for bullying, such as human resources, employee wellness, and management. Appraise strong work relationships, appropriate exercise, sleep, and nutrition as interventions to decrease stress and attenuate the effects of bullying Change communication styles with a holistic, nuanced approach and strong leadership to prevent a problem from escalating. Improvise responses for specific bullying situations, using scripts and cognitive rehearsal when warranted. Definitions and Prevalence Healthcare is a stressful field, even when effective teamwork and interdisciplinary communication are in place. Bullying behaviors may be difficult to detect at first, and managers are prudent not to overreact. However, bullying in healthcare is an increasingly prevalent issue. It can include repeated, health-harming mistreatment ranging from verbal abuse and humiliation to threats, sabotage or worse. Synonyms in the corporate world include incivility and lateral or horizontal violence. Aggression and violence from patients and visitors is a real threat, but healthcare professionals report hostility from their fellow professionals to be a greater concern. This hostility occurs with greater frequency than sexual harassment or various types of discrimination. Physical violence is rarely part of horizontal violence, which typically consists of bullying from someone with comparable authority. Intimidation, withholding clinical information or assistance, undermining, harassment, and constant criticism are all signs of bullying. Attacks delivered via task assignment or exclusion to erode professional competence and reputation are also forms of bullying. A bullying interaction involves repeated negative and unreasonable behaviors, often more than once a week, for greater than 6 months. Many of these interactions involve an imbalance of power, though that power may be social and informal. Office or hospital staff may view faculty to lack practical clinical skills, while students have limited rights and access to resources. If they feel entitled to better grades, students may bully professors. Although it is not as common, veteran nurses and physicians report bullying from newer nurses. Thus, bullying is sometimes complex and nuanced rather than clearly intentional. Often, it is not easily remedied by punitive policies directed against a clear aggressor. A cross-sectional descriptive study examined the prevalence of bullying among faculty members at schools of nursing offering a BSN or higher. They reported senior faculty and administrators as more likely to be bullies, and a significant correlation was found between meeting frequency and the report of bullying. Lacking is documentation of this in nurse anesthesia and similar literature about advanced nursing practice, physical therapists, and physician assistants. The implications of such acts can cause physical, emotional and psychological distress within and among practitioners—and potentially toward the patients under their care. Healthcare providers and facilities are becoming increasingly dependent on outcomes and quality of care for reimbursement. Healthcare professionals are an essential component of both of these. Maintaining a positive work and learning environment may prevent distress among students, and healthcare professionals and potentially promote quality care improvement. Students are especially vulnerable for multiple reasons, including the possibility that evaluations will suffer if they stand up for themselves. In certain circumstances, underreporting of these activities occurs due to lack of confidence in the institution to take action. Others may choose not to report bullying out of fear of retaliation, the fear of seeming petty, or the fear of becoming the target of more abuse if acting as a whistleblower. Often, educational and healthcare institutions fail to act on issues of incivility and have limited measures in place to address it. Nurses must become aware of their surroundings, as well as the internal and external resources available, should they find themselves or a coworker becoming a bullying target. Targets of bullying behavior can experience weight fluctuation, hypertension and angina, pain, headaches, and a litany of psychological effects—from fatigue and anxiety to post-traumatic stress disorder and suicidal thoughts. The effects of bullying are highly individualized and partly depend on the communication skills and emotional intelligence of targets. Self-control and clear thinking during tense situations reflect high emotional intelligence, but this is affected by the shared emotions and subsequent behaviors in workplace culture. Ethics and decisions are heavily influenced by peer behaviors, but self-monitoring and political skill decrease the incidence of bullying. This is because of empathy more than social capabilities. Leadership is an important facet of emotional intelligence because someone who cares little for others but possesses high emotional intelligence tends to bully and manipulate covertly. However, demanding jobs with little control and social support correlate highly with bullying. Autonomy is an important weapon to fight bullying. A stifling environment challenges communication and leads to errors that may result in a healthcare professional appearing less competent. A common thread is negative affectivity that causes more distress and nervousness than warranted by a situation. Negative affectivity is a personality variable that expresses the experience of negative emotions and poor self-concept. Negative affectivity produces a variety of negative emotions, including anger, contempt, disgust, guilt and fear. Nurses cite external emotional abuse as the most common form of bullying and often rely on support systems at work to deal with the situation. In contrast, secretaries and similar hospital staff seek social support from families and friends outside of work when bullied. People affected by a mental disorder caused by stress are often eligible for compensation. Bullying behavior leading to mental harm may qualify, and as performance decreases, work-related injuries increase. The benefits versus the costs associated with employers taking a proactive approach to bullying are 2: Indirect victims may become an issue. Rather than delays in procuring juice and saltines, studies show that bullying leads to increased patient mortality, wrong site and wrong patient surgery, foreign objects left in surgical wounds, and multiple medication and protocol errors. A poll of managers and employees across 17 industries produced some startling statistics. The commission suggested that all accredited programs take action. One recommendation is that all accredited healthcare organizations create behavioral codes of conduct and establish a formal process for managing unacceptable behavior. These codes of conduct should focus on respect, with a zero tolerance for intimidating behavior and a means to alleviate fear and retribution among those who report disruptive behavior. Effective policing requires transformational or congruent leadership rather than the more common transactional leadership. Improved productivity is the goal of transactional leadership, even if nurses are lured into working harder and longer in exchange for bonuses or overtime pay. Transformational leadership is the most effective leadership approach to improve workplace culture, since it is flexible and fine-tuned to the emotions of others. Congruent leadership fosters collaboration and the ability to resolve tense situations and people diplomatically. The CRNA must expect and demand excellent behavior across all environments. The healthcare system should strive to maintain a healthy, positive and safe environment for all staff, students and employees. It is important to promote a social climate with social norms that are free of lateral violence, bullying activity, harassment, and intimidation. The healthcare community must subscribe to the philosophy that lateral violence or bullying in any fashion constitutes unacceptable behavior. The development of a strong educational program requires training staff members to identify lateral violence and educate them about proper interventions and techniques to deal with it. How does one pick up the pieces and move forward after a bullying event? This does not mean they have easy choices. Many targets find themselves self-blaming when in reality they did nothing to provoke the inappropriate behavior and abuse. This self-blame can often trap targets, preventing them from taking steps to end the psychological violence. Once the self-blame ends, targets can focus on healing. Common resources to help regain confidence and have faith in the journey ahead include supports such as family, close friends and colleagues; professional therapists and counselors; legal attorneys specializing in employment law; and organizations such as BEHAVE Wellness Bully Elimination, Health, Advocacy, Violence Education. An oppressive work culture will extend past the barriers of a nursing floor or unit. Concerns about reporting systems, privacy and equitable treatment are valid, especially if the bully is in management. In some cases, wellness programs sponsored by employers can increase job performance while decreasing compassion fatigue and stress. The demand for pharmacists, nurses, and other providers is cyclical, and bullying has ebbed and flowed through the decades. Hospitals able to retain and recruit employees are conducive to high autonomy and employee leadership. In its absence, some institutions have turned to wellness models that penalize and simply pass healthcare costs to the employee rather than helping with bullying or any other problems affecting the health of nurses. Although wellness programs are better known for granting rewards for healthy behaviors, as they evolve amidst cost-cutting measures, the end result can be corporate bullying and lower morale. Happiness is an internal feeling, and to find happiness, it must first be defined. Gratitude practices can bring a sense of contentment, place things in perspective, and create inner happiness. Above all, when confronted with workplace bullying, health and well-being need to come first. Maintaining wellness is of paramount importance. Targets should ask themselves what they like to do to unwind and relax. What are they grateful for? How do they show compassion to themselves and others? The answers to these questions will help keep nurses grounded by providing a sense of happiness and comfort when coping with this tragedy. Increasing Resiliency Those feeling the effects of bullying often need to start a path to wellness with basic, practical steps. The various advantages and disadvantages of antidepressants and similar drugs to combat bullying are beyond the scope of this article, but targets must have the right attitude and take a holistic approach. This makes it easier to lose weight, relax, and deal with stress. Without some form of exercise, employees can create a vicious cycle by covering up low energy with coffee or sugar, which stress the adrenal glands. This is common due to the odd hours many nurses must work. Sleep deprivation also creates abnormal cortisol and other hormone levels that help the body deal with stress. Learning healthy methods to unwind and relax lessens the risks of alcohol and drug abuse as coping mechanisms. Healthy eating plays a major role, and magnesium is calming and works well as a sleep aid. Topical absorption through an Epsom salt bath or increasing magnesium intake through diet and supplements can assist in stress reduction. Emotional intelligence is key. Researchers tested women with autoimmune diseases to determine whether their symptoms and vulnerability to the disease related to emotional connectedness and control. They were asked about emotional attachment and the ability to understand and describe their own attitudes and emotions. Not surprisingly, the surveyed women tested highly for unresolved emotional issues and difficulty in understanding and controlling their feelings.
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