Stepping Out of the Shadows A story about bullying in nursing
AUTHORS Kathy O’Flynn-Magee, Lynne Esson, Ranjit Dhari, Raluca Radu, Samantha Mee, Suhan Ong, and Amy Fong-Yuk Poon
SCRIPT & LAYOUT Tania De Rozario
ART Rene Rebora
GRAPHIC DESIGN Alpha Lam
The creation of this novella was made possible by the University of British Columbia Teaching and Learning Enhancement Fund
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what is bullying? “a) ...any inappropriate conduct or comment by a person towards a worker [student] that the person knew or reasonably ought to have known would cause that worker [student] to be humiliated or intimidated but b) excludes any reasonable action taken by an employer or supervisor relating to the management and direction of workers [students] or the place of employment.”1
Effects • • • • •
Negative effects on morale and self-esteem Feelings of humiliation, invisibility, and intimidation Decreased confidence Fear, distress, anxiety, and depression Maintenance of power-laden hierarchies
• • • • • •
A lack of commitment to the profession Decreased performance and motivation Altered career decisions2,3,4,5,12,19,20,26,27,28 29 Newly graduated nurses leaving the profession 29 Decreased patient safety2,3,9,28 Taken up by those who have been bullied9,30,31,32
“By continuing to conceptualise workplace bullying as an inherent feature of nursing, we risk passive acceptance that bullying is a feature of nursing, rather than what it is — an abusive and harmful activity perpetuated within organisations.”25 Rather than solely focusing blame at the individual level, “locating bullying interactions within the realistic and complex context of health care reminds students and other stakeholders that to understand bullying we must first recognize and acknowledge the educational and systemic health care contexts in which it occurs. Such contexts arise from structural and organizational barriers which include, for example, heavy workloads, lengthy nursing shifts, acutely ill patients, worried families, staff sick calls, learners from a variety of health care professional education programs, and a culture that seems to normalize bullying.”24 38
Staying silent doesn’t work The likelihood of nurses and nursing students witnessing or experiencing bullying during their careers ranges from 17% to over 90%.2-5;7-12 Indeed, bullying is so prevalent that nurses are often characterized as ‘eating their young.’13-15 Nursing students may tolerate bullying as a ‘rite of passage’12,18 and may not report it because of fears of increased bullying, negative evaluations, or limited future professional opportunities.2,3,12,19,20,21 Sometimes, students are unaware of school policies,22 unsure how to report bullying,3 respond to bullying by “doing nothing,”10 and/or believe that nothing would be done.9 “No nurse should accept or tolerate a culture where bullying, horizontal violence, or workplace incivility exist.”6
Following a workshop about addressing bullying, a student said: “I want to work in a professional culture where we no longer hear ‘nurses eat their young.’ I see it as my responsibility to intervene when I witness/encounter bullying so that I can move nursing in this direction.”23
The CRAB© symbolizes nursing education workshops we designed using Cognitive Rehearsal16,17 to Address Bullying (CRAB). We added forum theatre35,36 as a creative form of pedagogy to support students to address bullying if they witness or experience it in nursing education.
As one student participant said: “The Workshop emphasized the fact that no one starts as a bully, and it is important to remain self-reflective to make sure you don’t become one.”24 Original watercolour by Skye Maitland UBC BSN grad 2018
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OUR TOP TEN TIPS 1. Understand what bullying is. WorkSafeBC’s1 legislated definition is one tool to use. 2. Reach out if you witness or experience bullying. Don’t do nothing. 3. Identify your ‘go to’ person within the institution in order to have a safe(r)33 space to disclose and discuss. 4. Get the support you need. Witnessing or experiencing bullying can affect our mental health and wellness. 5. Name bullying for what it is and know that it is not your fault. 6. Check if your institutions (education and health care) have specific policies in place to address bullying. Are there clear and transparent reporting mechanisms? Are policies and procedures respectful of all parties involved? 7. Attend or advocate for bullying content in nursing curricula in schools and health care environments. 8. Use strategies such as cognitive rehearsal to practice scripts, then practice, practice, practice. 9. Know that bullying is not simply an interpersonal interaction. Consider the context in which bullying occurs. Are there structures or processes in place that allow bullying to occur? 10. Look after yourselves and each other.
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