Nonphysical hos-lity in nursing educa-on & prac-ce Recognizing Workplace Hos-lity
Nonphysical hos-lity in nursing educa-on & prac-ce
Recognizing Workplace Hos-lity
Aggression Escalates to Violence
While aggressive behavior refers to one incident, bullying or violence involves repeated a7acks against the target, crea9ng an on-‐going pa)ern of behavior that creates a destruc9ve,
toxic workplace for all employees.
Confusion in the language
As researchers have explored hos-lity in the workplace over several decades, differing
terms have been defined and used to describe the behavior represented
These varying terms generally describe a class of
aggressive behavior universally exhibited across professional disciplines, workplace
seHngs and geographical loca-on
Confusion in the language
Earlier studies may refer to:
Hos9lity Bullying
“Nurses Ea9ng Their Young” Interpersonal Conflict
Vic9miza9on Pe7y Tyranny
Emo9onal Abuse
Confusion in the language Later studies may refer to:
Horizontal Violence Interac9ve Workplace Trauma
Workplace Incivility Nurse-‐to-‐Nurse Aggression
Mobbing An9social Workplace Behavior
Incivility Ver9cal Violence Lateral Violence
Confusion in the Language
While there have been many defini-ons and
terms used to describe this behavior depending upon the researcher, the discipline
and the study . . .
Agreement has been reached on several key points in defining bullying/hos-le behavior
Confusion in the language
Bullying behavior is iden-fied by the following characteris-cs:
Consistent, repeated behavior from bully to vic9m Occurring over a period of 9me
Intensity resul9ng in harm to the vic9m Real or perceived power disparity between bully and
vic9m
(Lutgen-‐Sandvik 2007)
No confusion in the meaning
It is the malicious intent
and impact on the recipient that characterizes workplace bullying
The link between terms
Research on anger, aggression, bullying and verbal abuse – terms used by different professional groups -‐ is relevant because
these behaviors are all ways in which hos-lity expresses itself
(Bartholomew 2006)
the link between terms
In this course the focus is on coping with nurse-‐on-‐nurse hos-lity, par-cularly horizontal or lateral hos9lity between co-‐workers, through
the use of bullying behaviors
Descrip-ve terms used depend upon the focus of each study cited
Key Defini-ons
• Workplace Bullying • Ver9cal Violence • Horizontal Violence • Mobbing
Key Defini-ons
Workplace Bullying “Repeated inappropriate behavior, direct or indirect,
whether verbal, physical or otherwise, offensive abuse, in-mida-ng, malicious or insul-ng behavior or abuse of
power conducted by an individual or group against others, which makes the recipient feel upset, threatened,
humiliated, or vulnerable [and] which undermines their self-‐confidence and may cause them to suffer stress”
(2008 Task Force on the Preven-on of Workplace of Bullying. Dublin, Ireland:
Health & Safety Authority, p. 5.)
Key Defini-ons
Bullying
“Repeated and persistent nega-ve ac-ons toward one or
more individual(s), which involves a perceived power imbalance and
creates a hos-le work environment.”
(Salin 2003)
Bully Seeks Control
Co-‐Workers Lose Control
Co-‐Worker
Co-‐Worker
Bully
Key Defini-ons
Vertical Violence Bullying or hos-le behavior expressed by senior to junior
colleagues
The power differen-al in this rela-onship is overt and the bully can take advantage of tacit organiza-onal support for empowerment along with managerial sanc-ons to
punish the vic-m
An Example Vertical Violence
You are one of the most competent nurses in your unit but somehow you cannot sa-sfy your
supervisor. She unfairly cri-cizes your work, manages to exclude you from informal mee-ngs
with other staff members where cri-cal informa-on is exchanged, and loudly berates you in the hallway for missing impossible deadlines.
Chances are it’s not your fault, you’re being
bullied.
Key Defini-ons
Mobbing Bullies form alliances and engage in repeated destruc-ve behavior
toward individuals or groups.
Mobbing behavior not only targets co-‐workers, but can be directed upward to supervisors
and managers.
• Nurse Manager
• Supervisor
• Co-‐Worker • Co-‐ Worker
Bully Bully
Bully Bully
An Example Mobbing
You have just been promoted to supervise your unit and it’s not siHng well with prior colleagues who now report to you. They repeatedly call in sick at
the last minute, your possessions disappear, charts go missing, and snide comments are made
to you and behind your back.
Chances are your colleagues have banded together and targeted you for group bullying
behavior.
Key Defini-ons
Horizontal Violence Occurs at similar levels across peer groups: team members, nurse-‐to-‐
nurse or manager-‐to-‐manager
Expressions of Horizontal Violence may be conscious or unconscious
behavior (Taylor 1996) Par-cipants in Horizontal Violence may
be ac-ve or passive par-cipants
Staff Nurse
Staff Nurse
Staff Nurse
Staff Nurse
Staff Nurse
Horizontal violence
Researchers have provided several different defini-ons of the term horizontal violence: “Overt and covert non-‐physical hos9lity, such as cri9cism, sabotage, undermining, infigh9ng,
scapegoa9ng and bickering” (Duffy 1995)
Horizontal violence
“Unwelcome repeated hos9le aggressive behaviors (physical or non-‐physical) of one colleague towards another” (Einarsen 1999)
“Aggressive and destruc9ve behavior of nurses
against each other, the demeaning and downgrading of others through unkind words
and cruel acts that gradually undermine confidence and self-‐esteem” (Nazarko 2001)
An Example Horizontal Violence
You have just been hired and are excited about your new job, but on your first day a co-‐worker makes a derogatory remark
about the program from which you graduated. During the first week, con-nuing comments are dropped about your lack
of skills and experience. Disparaging remarks are made in front of pa-ents and co-‐workers, undermining your
professional capabili-es. At the end of the first week you know that you have made a serious mistake in taking the job.
Chances are you’ve been introduced to the bully you will have to live with in your new job, and you’re her newest vic>m.
Common Bullying Behaviors Griffin (2004) iden-fied the following behaviors as the most common toolbox of bullies in the nursing workplace:
Nonverbal innuendo Verbal affront
Undermining ac9vi9es Withholding informa9on
Sabotage Infigh9ng
Scapegoa9ng Backstabbing
Failure to respect privacy Broken confidences
Other Tools of the Workplace Bully Bullies use many tools to vic-mize their colleagues:
In9mida9on Disinterest and undervaluing
Discouragement Threats
Humilia9on Excessive or unjust cri9cism
Verbal abuse and rude comments Verbal innuendo
Exclusion and isola9on Implica9ons of repercussions for exposure of conflict
Failure to support in a colleague’s defense False accusa9ons
Other tools of the workplace bully
Some tools of the bully are illegal or ac-onable if brought to light:
Physical assault Sexual harassment Sexual In9mida9on
Slander Property damage or theb
Other tools of the workplace bully Manager have addi-onal tools available:
Ver9cal Threats Reduced income Denying benefits
Termina9on without cause Discrimina9on
Undeserved performance evalua9ons Unsafe assignments Denying opportunity Arbitrary instruc9ons
Behavioral typology of bullies
Bullies develop a par-cular style over -me
Researchers have amempted to provide a
framework for understanding bullying types to assist in iden-fying style and developing
appropriate strategies in dealing with each
Behavioral Typology of Bullies
Rayner (1997) grouped bullying behaviors into several categories with examples:
Threat to professional status Beli7ling opinion, public professional humilia9on,
accusa9on regarding lack of effort
Threat to personal standing Name-‐calling, insults, in9mida9on, devaluing with
reference to age
Behavioral typology of bullies Isola8on
Preven9ng access to opportuni9es, physical or social isola9on, withholding of informa9on
Excessive overwork Undue pressure, impossible deadlines, unnecessary
disrup9ons
Destabiliza8on Failure to give credit when due, meaningless tasks, removal of responsibility, repeated reminders of
blunders, secng up to fail
Behavioral Typology of Bullies
Hutchinson (2009) grouped bullying behavior into the following types:
Personal ACack The personal iden9ty and self-‐concept of the vic9m are
threatened through isola9on, in9mida9on and degrada9on
Behavioral typology of bullies
Erosion of Professional Competence and Reputa8on The professional iden9ty is damaged and the result
is limited career opportuni9es
ACack Through Work Roles and Tasks Work obstruc9on, including denial of due process and economic sanc9ons are used to undermine the
vic9m
Is The Bully Hiding?
Bullies typically exhibit a lifelong preference of bullying styles which have been reinforced by their success in establishing control over their vic-ms -‐ some prefer to operate in the open
and others are more subtle
While both can inflict considerable damage on others, subtle bullying styles are more
difficult to recognize, confront and manage
Is The Bully Hiding?
Examples of Overt Bullying Behavior
Abusive, insul9ng or offensive language Behavior or language that frightens, humiliates, beli7les or degrades
Comments about appearance, lifestyle or family Regularly targe9ng someone with pranks or prac9cal jokes
Interfering with an individual’s personal effects or work equipment Physical assault or threats
Cri9cism delivered with yelling or screaming Direct threats, physical in9mida9on and/or sexual harrassment
Is the bully hiding?
Covert Bullying Behavior
More subtle and less public behavior that undermines a vic9m Much harder to manage for vic9ms Oben not recognized by supervisors
Keeps peers from coming to the defense of the vic9m Does not involve a paperwork or other incrimina9ng trail to use for complaints by
vic9ms
Is the bully hiding?
Resul8ng stress turns the spotlight on the vic8m while the bully remains in the shadows –
the vic>m can appear to be the problem
Covert Bullying From a Supervisor
Supervisors have many subtle ways of undermining their vic8ms:
Unreasonable workloads for long periods of 9me
Secng impossible 9melines or changing deadlines frequently Consistently assigning tasks beyond an employee’s skill level
Ignoring a person to isolate them Deliberately denying access to informa9on or resources Unfairly denying en9tlements such as leave or training
opportuni9es
Covert Bullying From a Co-‐Worker How colleagues can make each other miserable:
Excessive cri9cism Verbal abuse including comments that are rude or humilia9ng
Verbal and non-‐verbal innuendo Exclusion from groups and important informa9on
Implica9ons of repercussions for exposure of conflict Failure to defend a colleague
Scapegoa9ng Spreading lies about the vic9m
Broken confidences Backstabbing
Intent and Systema-c In-mida-on
While every person is occasionally capable of behaviors that appear to be “bullying”, this is different from the intent to use systema-c
in-mida-on to control others.
Individuals without the intent to bully can learn to change their style.
Inten8onal bullies, however, oLen require specific interven8on by vic8ms, co-‐workers, managers and companies to force changed
behavior
Physical results of stress MacIntosh (2005) catalogues many of the physiological impacts of violence in the workplace for both vic-ms and witnesses:
Frequent Headaches
Dry Throat Gastrointes9nal Problems Changes in Body Weight
Sleep Disturbances Diminished Energy
Exhaus9on Disrupted Concentra9on
Hypervigilence
Physical results of stress
Other researchers describe a myriad of problems that con-nue and can worsen with -me, even aber leaving the toxic work environment:
Cardiac arrhythmias
Cardiovascular Problems (Hypertension to Strokes, Heart A7acks)
Adverse Neurological Changes (Neurotransmi7er Disrup9on, Hippocampus Shrinkage)
Physical signs of stress
Immunological Impairment
(More frequent infec9ons of greater severity)
Fibromyalgia and/or Chronic Fa9gue Syndrome
Diabetes
Skin Disorders
Physical Signs of stress
Bullied workers oqen demonstrate a variety of physical symptoms from related stress:
Complaints of Nausea Tremors of the Lips, Hands, Etc.
Feeling Uncoordinated Chills
Profuse Swea9ng Diarrhea
Physical signs of stress
Rapid Heartbeat
Rapid Breathing
Reports of Elevated Blood Pressure
Complaints of Chest Pain
Uncontrollable Crying
Headaches
Psychological impact
MacIntosh also catalogues a number of longer term serious problems reported in the research for vic-ms and, to a lesser extent, witnesses:
Depression
Complex Post Trauma9c Stress Disorder (CPTSD)
Burnout from depersonaliza9on and lack of control
Maladap9ve responses such as substance abuse and overea9ng
Signs of emo-onal stress
Emo-onal stress symptoms may include:
Anger and irritability
Decreased self-‐esteem, increased self-‐doubt
Lack of mo9va9on
Feelings of failure from being unable to meet expecta9ons
The Responsibility For Change
Nurse-‐on-‐nurse hos-lity affects everyone associated and any of these toxic behaviors can pertain to:
Students Faculty
Experienced Nurses New Nurses
Nurse Managers Nurse Administrators
The responsibility for reducing this destruc-ve behavior
rests with each nurse in each situa9on and in every place of work or study.
For details on slide nota9ons see bibliography included in this course