A new report on bullying by workers in Pennsylvania health-care settings found just 44 examples in two years, but it looked only at cases that were documented and could be linked to patient safety.
The new study was prompted by requests to the Pennsylvania Patient Safety Authority from health-care facilities that were concerned about how to address workplace bullying, said Kelly Gipson, a patient safety liaison and co-author.
Bullying in health facilities is important not only because it’s hard on employees but because it can impair patient care, the report said. It makes it harder for employees to work together and may contribute to “low worker morale, absenteeism and high rates of staff turnover.”
Susan Wallace, a patient safety analyst at the authority, said poor communication is often a factor when patients are harmed during treatment. “We want there to be open, honest communication because that’s what’s best for the patient,” she said. No one, she said, wants a worker to feel too intimidated to tell a surgeon, ” ‘Hey, you’re operating on the wrong leg,’ or maybe, ‘We’re missing a sponge.’ ”
Wallace analyzed Patient Safety Reporting System records from July 1, 2014, through June 30, 2016 – the state gets about 200,000 safety reports a year – and found 44 that met their definition of bullying. Following the lead of the Workplace Bullying Institute, they looked for instances of repeated, targeted mistreatment involving verbal and nonverbal abuse and sabotage. They searched for keywords like bully and threat because, unlike, say, falls, there is no standard way to report staff intimidation.
Thirty-four cases involved doctors who engaged in verbally abusive behavior. Nurses or technicians were the bullies in the other cases. Twelve events were witnessed by patients. Wallace and Gipson did not know who was being bullied but said safety reports typically come from nurses.
Several examples cited in the report involve employees who were brusque and dismissive when questioned or prompted to adhere to institution standards. A nurse yelled at other nurses after she was asked about documentation. She said, “How dare I question her,” a coworker reported. A nurse called a doctor to report a change in vital signs and ask if he wanted a cardiologist to see the patient. He repeatedly called the nurse “incompetent” and said to never call him again or tell him what to do. In a third case, a surgeon insisted on “modifying equipment in a manner that was against hospital policy,” even after a nurse brought the violation to the surgeon’s attention. “The nurse stated that she was being forced to practice contrary to hospital policy,” the report said.
According to the report, the Workplace Bullying Institute estimates that 27 percent of American adults have experienced workplace bullying and an additional 21 percent have witnessed it.
Renee Thompson, a nurse who now works full-time helping health organizations deal with bullying, said there were likely many more cases of bullying than the patient safety authority’s study found. “I think that’s so under-reported,” she said of the 44 cases.
Thompson, who was quoted in the authority’s report, conducted many focus groups with nurses while she was working on her doctorate. During that time, she helped her employer create professional development programs. “All the nurses wanted to talk about was how badly the other nurses treated them,” she said. Her first impulse was to say that’s the way it had always been. Then she decided to make it the focus of her doctoral program and, ultimately, her career. She is now CEO and president of RTConnections LLC in Pittsburgh.
She said many people define bullying too broadly. “People tend to label all bad behavior bullying,” she said. A physician who treats nurses with condescension is not necessarily bullying. People under stress might be sharp or nasty with one another, but that’s often incivility, not bullying. It is not bullying for a manager to hold an employee accountable.
To qualify as bullying, Thompson said, the behavior needs to be aimed at a specific person, and be harmful and repetitive.
“In every organization, there is some bullying, but really not a lot,” she said. “There’s a lot of incivility.”
She said many health-care managers are ill-equipped to deal with complaints. “I find in general organizations do not have a good process in place to be able to do that,” she said.
Thompson said a surprisingly effective response to bullying is to say, “I’m offended by that comment.”
Enduring quietly rarely works. “Silence is an agreement,” she said. “If you don’t say anything, you basically give that person power over you.”
In response to the study’s findings, the safety authority’s staff developed a card-size deescalation tool that health-care workers can keep with their name badges. The tool crystallizes the D.E.S.C. approach to bullying: Describe the behavior, Express how you feel, Suggest alternatives, outline Consequences. A victim, the card suggests, might say, “When you question me in front of a patient, it makes me feel uncomfortable.” She could then ask to talk in private, where the conversation would be more productive. “During a private conversation,” she could say, “I would feel less embarrassed and could supply more information.”