Navigating incivility and bullying in healthcare

There is an epidemic of bullying and incivility in healthcare.

It may be one isolated incident or a series of events that can occur at any time in your career. First, let’s get the definitions right: The American Nurses Association (ANA) defines bullying as “repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient.” Incivility is more difficult to label but is “one or more rude, discourteous, or disrespectful actions that may not have a negative intent behind them.”

The prevalence of these deep-rooted issues and disruptive behaviors are often the result of challenging work environments, burnout, and a lack of professional leadership skills.

The tone for the culture of an entire organization is set by upper-level leadership that may not possess the skills or education on strategies to facilitate a healthy work environment. This can have a trickle-down effect and influence staff in a harmful way, and in turn, impact patient care negatively.

No one in healthcare is spared from these toxic behaviors. From nursing students to administrators, these disruptive behaviors impact all members of the healthcare team and the care we provide our patients.

According to The Healthy Workforce Institute,  93% of healthcare workers have either experienced or witnessed acts of bullying, and 60% quit their jobs related to workplace bullying and incivility. These staggering statistics should make everyone sit up and take notice of this exceedingly alarming problem.

This year, I implemented a Peer Support and Mentoring Program in my department because I recognized that my unit would benefit from a program like this. We had a strong need for peer support, as we had undergone many leadership changes, were maneuvering a complete department restructuring while onboarding multiple new staff, and were still amidst the COVID-19 pandemic.

The first topic discussed was toxic work environments and difficult work relationships. While reaching out to staff and researching the program framework, I discovered just how prevalent these issues were among staff at different points in their career and, unfortunately, throughout the healthcare delivery system. 

I have experienced these challenging problems as a nursing student, a new nurse, and even a seasoned nurse. I will never forget the helplessness I felt in managing these problematic situations or how inadequately prepared I was to address and escalate situations as appropriate.

I even, at one point, debated leaving a role I loved related to these tremendous dilemmas. This led me to be a strong advocate for healthy work environments, and it’s why I created a group on NurseSocial called Healthy Work Spaces.

The purpose of this group is to have meaningful discussions on creating and maintaining a healthy work environment and discussing strategies to deal with conflict, bullying, incivility, and disruptive behaviors.

Here are three strategies I found helpful to navigate bullying and incivility (they can also be found in this video discussion with Dr. Renee Thompson, DNP, RN CSP of the Healthy Workforce Institute and on NurseSocial):

Become aware of your personality traits and disruptive behaviors.

Completing personality assessments can identify your strengths and weaknesses and those of your peers. Doing a self-assessment is the first step in creating a healthy work environment, as disruptive behaviors such as bullying and incivility can affect the entire culture of a department. Doing an inward reflection of yourself and becoming self-aware is critical before you can identify these in others.

Many are unaware that their actions and behaviors are disruptive. Inward reflection is a great way to be sure you are not the problem or a contributor. Leading by example and conducting yourself in a way that is professional and respectful of others is critical, and lays the groundwork for others to follow. 

Use scripting when confronting a coworker or peer.

I have found scripting tremendously useful, as I have always struggled with conflict resolution and finding the right words in the moment. Using conversation starters and thinking about what you want to say ahead of time is extremely helpful.

Leading with statements such as, “Our relationship is important to me…” and using words like, “You may not realize this but…” and then following these with, “Can we talk about this…?” These statements set the tone for a meaningful and productive conversation, as well as mutual respect, and naming the behavior instead of attacking the individual.

Give recent examples of what behaviors you are confronting the coworker about. Separating the behavior from the individual is critical in setting the tone for the conversation as a discussion instead of a personal attack. 

When you are in a difficult moment, it’s always okay to inform the individual that you would like to discuss the topic at a later time. Making a statement like, “Let’s continue this discussion after our shift and in a more private setting,” or “Would you like to grab a coffee tomorrow and see how we can bridge our differences?”

This gives everyone a chance to cool off and allows you time to prepare for the conversation and utilize a quieter environment. It also diffuses a tense moment, one that may be drawing attention from others, taking away from patient care, or happening in front of other staff or patients. Nothing is worse for a patient than seeing a heated exchange between members of their care team, which reduces trust in their providers. 

Document your conversation.

These conversations don’t always go the way you expect. Documenting the conversation is a great way to reflect that things have improved or that you have attempted to confront a persistent problem that continues. It is also a record of events that have transpired and a form of journaling that can act as an emotional outlet for how the situation is making you feel.

Recording each exchange is helpful should you need to escalate a problem or look back at how a concern that was improved was managed. What we tolerate sets the tone for the entire work environment and culture, which is why escalating an ongoing problem is crucial for yourself and others.

Sending a follow-up email after meeting with your leadership team regarding any issue is a great way to set up a paper trail of documentation and helps to establish accountability for all involved. Be sure the language in the email is strictly factual and professional, and created in a way that it would be acceptable if it was forwarded to more senior leadership.

Bullying and incivility in healthcare must be eliminated through strong nursing leadership and consistent accountability. Standards must be set, and individuals need to be responsible for their disruptive behaviors.

Those in leadership positions must lead by example and set a tone of zero tolerance for bullying and incivility by following through with consequences for staff exhibiting these disruptive behaviors. Education on conflict resolution, specifically regarding bullying and incivility, must be at the forefront and implemented in every healthcare organization