9781452512402 copy Balboa press publishing

The

DARK SIDE of

NURSING I NGR I D T E R E SA PRY DE

Copyright Š 2014 Ingrid Teresa Pryde.

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ISBN: 978-1-4525-1239-6 (sc) ISBN: 978-1-4525-1240-2 (e) Printed in the United States of America.

Balboa Press rev. date: 03/13/2014

ACKNOWLEDGEMENTS I would like to acknowledge each author whose knowledge has contributed to the strength of this book. Their written work has enabled me to increase awareness with an insight, perseverance to establish pertinent legislation and have caused an eagerness to bring to the forefront the crime of bullying.

I would like to commend the victims who have been brave enough to tell their story.

DEDICATION To all nurses who have been (and currently are being) bullied To all those victims who lost their lives through suicide in an attempt to cope with bullying To my two youngest children, Sasha and Martin Junior, who were twelve and fourteen around the time and were exposed to a very distressed mother who was unable to provide the parenting she would have liked to To Rachel, who at eighteen and needed support with difficult situations she faced, did not get the understanding she needed To my husband, who supported, listened and was particularly caring through the most demoralising experience I had one June morning To my two eldest children, thank you for your support and encouragement as well, especially during the period of writing the book To God, who gave me the courage, strength, insight, and drive to continue the task of writing until it was complete

I decided to write my story on bullying when I felt totally demoralised following all the incidents that took place, particularly one. To head down a legal path seeking retribution would have meant the experience of more anxiety and stress. I strongly believed that writing a book would be therapeutic for my wellbeing. It became a documented report of events that affected my family and me in a monumental way.

In the course of my writing, I discovered that the literature was saturated with recorded events, opinions, and theories to hinder bullying, offer advice, or just report experiences. The strong evidence of its perpetration in nursing and in the adult workplace in general overwhelmed me.

I decided that the best place to start was the classroom. Education and awareness is the best way to deal with any problem. Supported by literature, theories, and legislation (or the lack of it), I chose to take the written journey of culminating my personal experiences together with advice on dealing with the demon that is perforating the work culture.

Supported by strong literature and personal experiences, I created an academic and narrative report, anticipating that the two variances would support each other and make an interesting read.

The life-changing experience that takes place following chronic bullying is almost permanent and can possibly change if a different path is explored. I chose to impart the knowledge I gained and the harrowing experience I went through to my readers in the hope of not only helping struggling individuals but also providing a

literature-based report that would assist in setting up “management of the bully� as a subject in the classroom.

It would be my utmost desire that, through this report, antibullying tactics are explored and that anti-bullying becomes an elective subject in universities and colleges and students are encouraged to engage in learning the subject.

CONTENTS Chapter 1

Teresa’s Narrative: Early Memories ...............................1

Chapter 2

The Bully Unmasked ......................................................21 2.1 What constitutes a bully? ........................................21 2.2 Literature...................................................................23 2.3 The Nature of Nurses / bullying a breeding ground .....................................................30 2.4 The Right Job ............................................................ 31 2.5 The Office ..................................................................37 2.6 Lack of Autonomy ...................................................40 2.7 The Event ..................................................................41 2.8 Management Plan ....................................................46

Poem Why Do You Treat Me So? .........................................................51 Chapter 3

Running the Gauntlet ....................................................53

Chapter 4

The “Untouchables” .......................................................71 Introduction ....................................................................71 4.1 Victimisation ............................................................71 4.2 Professional direction of new nurses .................... 74 4.3 Scenario .....................................................................75 4.4 Anxiety ......................................................................76 4.5 Research ....................................................................77 4.6 Power and its downfall ............................................78

4.7 Theories .....................................................................79 4.8 Harsh words and hurtful behaviour .....................80 4.9 Consequences and solutions ..................................88 4.10 Stress ........................................................................89 4.11 Pathophysiological process of stress ....................91 4.12 Conclusion ..............................................................95 Chapter 5

A New Beginning‌ And an Old Problem...................97

Chapter 6

Back to Australia .......................................................... 119

Chapter 7

The Victims ................................................................... 141 7.1 Staff Meeting, Unexpected Guest......................... 141 7.2 Meeting with Agnes (team leader) and Jean (educator) ...............................................143 7.3 Meeting with Viola (Manager) Human Resource Manager Mr Nelmes and Jean (educator) .................................144 7.4 Disciplinary Action................................................145 7.5 Email ........................................................................147 7.6 Solicitor’s letter to Viola Nurse Manager ............147 7.7 Inability to attend meeting ..................................153 7.8 Report to manager in response to accusations (excerpts) ...........................................154 7.9 Formal complaint ..................................................157 7.10 Final Letters...........................................................160 7.11 Investigation: subsequent report on bullying ..162 7.12 Verbal accounts of bullying ................................163 7.13 Written accounts of bullying ..............................164 7.14 Conclusion ............................................................173

Chapter 8

Bullying and the Law ...................................................177 8.1 Legislation against Bullying in the workplace ...177 8.2 Difficuilty establishing bullying legislation ...............................................178 8.3 Europe proactive to create legislation against bullying .....................................................179 8.3.a United Kingdom ..........................................180 8.3.b Australia .......................................................180 8.3.c Canada........................................................... 181 8.4 Overview .................................................................182 8.5 The Free World .......................................................183 8.6 Advice by authors with strategies .......................185 8.7 Constructive Dismissal .........................................189 8.8 Power hungry .........................................................190 8.9 The financial cost of bullying ............................... 191 8.10 Conclusion ............................................................194

Chapter 9

Statistics and Characteristics .....................................195 Introduction ..................................................................195 9.1 Types of Bullying....................................................196 9.2 Incidence .................................................................197 9.3 Perpetrators / Incidence ........................................199 9.4 Disruption to wellbeing.........................................201 9.5 Physicians perpetrators of bullying .....................205 9.6 Employers held accountable .................................206 9.7 Misunderstanding..................................................206 9.8 Organisational culture responsible for bullying ............................................................207 9.9 Bystanders role in bullying ................................... 210 9.10 Character traits of the victim ............................. 211

9.11 Character Traits of the Bully .............................. 214 9.12 Bullying: worst kind : Murder ............................ 217 9.13 Bullies reoffend ..................................................... 218 9.14 Conclusion.............................................................220 Chapter 10 Reform and Education.................................................223 Introduction ..................................................................223 10.1 Micro Bully Reform .............................................224 10.2 Macro-Bully Reform ...........................................231 10.3 Education ..............................................................238 10.5 Role play ................................................................241 10.6 Learning Cycle; of Star Legacy ..........................242 10.7 Strengths of role play ...........................................243 10.8 Scenarios to role play ...........................................244 10. 9 Advantages of role play ......................................245 10.10 The disadvantages of role-play ........................247 Stand Tall..............................................................................................249 Chapter 11

Self-Differentiation and the Problem of Bullying ...251 Introduction ..................................................................251 11.1 Definition ..............................................................252 11.2 Challenge ...............................................................252 11.3 Differentiation is:- ...............................................253 11.4 Self-Differentiation: A Mediating Factor to Bullying Antecedents ..........................256 11.5 Differentiated person ...........................................256 11.6 Conclusion ............................................................259

Chapter 12 Teresa Fights Back........................................................261 An Anonymous Poem of Encouragement Unknown ......................272 “Angel” Sarah McLachlan ..................................................................273

CHAPTER ONE

Teresa’s Narrative: Early Memories

The second youngest of nine children, Teresa was born in the late 1950s in Bangalore, South India, where she lived in a relatively inexpensive home with her eight siblings. Her eldest sister married when Teresa was two years old.

One of Teresa’s fondest and earliest memories was of her eldest sister visiting the family home. Living in far north of India, in Delhi, meant that her visits were infrequent. Antoinette, her older sister, was a pseudo mum to the five-year-old, and her arrival would usually infuse a whole new excitement and a breath of fresh air into the family household. The little girl loved waking up to the sound of her mum and sister chatting away in the kitchen as they prepared their famous Indian breakfast.

Teresa’s father worked as a fitter and turner for the Indian Railway. This meant that the family enjoyed free travel passes to nearby towns, a real treat for the young family through the early growing years. The excitement was unbearable when quick trips were planned. The railway job also involved transferring to different 1

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places, so it was not unusual for the children to be separated from time to time.

Making ends meet was a problem, so Mum worked as a seamstress for nearby British families and, to the delight of the younger children, received special treats from her employers. One such gift was a doll.

Teresa loved her dolls, and her earliest memory was receiving one in particular as a gift. Teresa named her Rosie, the ultimate name for a doll with cheeks as pink as a rose. Her mum encouraged the interest and, much to Teresa’s delight, regularly made little dresses for Rosie.

Teresa was always extremely excited to get home from school so she could change Rosie’s clothes and prepare her for playtime.

The little girl spent a lot of time on her own, enjoying this solitary life. Some thought she bordered on being a loner. Basically, Teresa was a reflective person, a bit perplexing, one might add. She often gave the impression that she was on another planet. In fact, she was often lost in thought.

One might ask, “How far can the thoughts of a five- or six-yearold progress?”

She would reflect on how people looked, what they said, and the reason behind what they said. She enjoyed thinking about the general character of people, as it were, from a child’s perspective. Her older siblings often thought this behaviour to be odd. She sometimes seemed to be in her own little world. Perhaps the big family was a bit overwhelming for the growing girl; her quirky personality drew attention to herself. Her siblings would tease her, and she would get upset.

Sometimes, she would think, I am not what you believe me to be, and hopefully, I will prove it to you, one day. Other times she would lash out in anger, which brought a bigger reaction from her siblings, she soon learnt that to control her anger was the best option.

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Christmas was the highlight of the year. The very air would come alive. Teresa’s mum would sew new dresses and new shoes would be bought to complete the outfit. In fact, the whole family would be spruced up for that special day. Putting up decorations was another exciting part of the festive season. The crib would be the centrepiece.

Teresa’s older brother would come up with fresh and creative ideas each year. The year he grew grass on a tray for the crib was the first— and best—ever. It was an awesome year, as Teresa did not believe he could grow grass indoors. However, when the sprouts began to appear, she was thrilled.

The true meaning of Christmas was honoured in the family home.

While growing up, the children were well aware that conventional holiday preparations were centred on the birth of Christ. Teresa’s mum, with great labour, would prepare special sweets. With eagerness and excitement, all the siblings would gather around to assist in the preparations of traditional Christmas treats. The anticipation of the pending Christmas Day would create an atmosphere unique to that time of the year.

Like Christmas all over the world, the family would sit down to a well-cooked meal, but not before attending church and paying respects to the aunties and uncles who lived close by. The special Christmas sweets would be brought out that day, and there would be enough to last a while during the festive season. Traditionally, a week of fun and frolic followed Christmas Day, and it remained a good time to catch up with extended family and friends.

Birthdays were also considered special in the home. The children were always made to feel like it was their exclusive day. Each child took pleasure in not having to do chores on that day (or not being yelled at). As a result, Teresa, the birthday girl, would behave and feel like a princess. In a large family, a birthday was an ideal occasion, a 3

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good time to distinguish that one unique child apart from the others and say, “Hey, this is your extraordinary day!” It worked remarkably well, so much so that Teresa sometimes felt sad as she anticipated the wonderful day coming to an end.

In future years, Teresa would follow the same practice with her own children and look at them with tenderness when they said, “I do not want my birthday to finish, Mummy.” She sometimes went a step further and gave the child a day off from school. It worked extremely well with the younger children. They enjoyed having special time with Mum, and it gave them a chance to discuss any burning issues they were experiencing at school. It also provided Mum an opportunity to chat and bond with her birthday child.

Teresa remembers reasonably well that historical moment, November 22, 1963, when John F. Kennedy was assassinated. A week or so later, she clearly remembered her mum and sister following the funeral on the radio during the early hours of the morning. John Kennedy was well respected in India, especially the way in which he articulated his speeches. One such phrase, which frequently arose, was this famous quote, “Ask not what your country can do for you.

Ask what you can do for your country.” The philosophical people of India, who admired his passion and charisma, highly regarded his speeches. The perplexed seven-year-old Teresa was unable to understand why the people around her were shedding tears over the death of a person they had never met. Oh well, he must have been important, she thought as she snuggled under the sheets and tried to get back to sleep. Grown-ups are hard to figure out.

Some years later, she would learn that Kennedy was an important person and the consequences of that fateful day would result in ongoing editorials about that awful event, the assassination of the president of the United States.

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All was not pleasant for little Teresa when her family decided that the cost of caring for so many children was proving a financial drain. As a result, her two older sisters were sent to boarding school at a convent in the southern India countryside. Teresa missed her sisters horribly, especially when it came to walking to school. She would cry most days. Occasionally, her older brothers would take her to school if they were free, but the thirty-minute walk to school on her own was the biggest issue she faced. Her mum was unable to accompany her, due to the several chores waiting to be performed for the large family, beginning with getting Teresa’s dad ready to leave for work at 5:00 a.m.

Just after breakfast, Mum would start planning lunch. Teresa did not want to burden her already busy mum with a walk to school. She was determined to manage on her own. She often worried about how her mother worked endlessly—almost all day—in the kitchen, resting only when she went to bed at night.

Teresa was no genius. She was of average to above average intelligence; however, family circumstances and social factors resulted in her academic underachievement. One of the key issues, initially, was that she had to get around on her own. Another was that she had the misfortune of having friends who did not treat her well.

One friend in particular sometimes talked Teresa into sharing her lunch in return for her friendship. Feeling intimidated by this girl, she would oblige, however, soon Teresa discovered that the so-called friendship would vanish as soon as the meal was over. Her short-lived friend would team up with another girl to start a fight, mocking, poking fun, and ridiculing the young Teresa for no rhyme or reason.

The bullying lasted almost two years on and off and became a very stressful period for the seven-year old; she was unable to live a normal life and would go home from school distressed on several 5

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occasions. Teresa’s mum intervened at times, and the bullying would stop for a little while, but it would re-ignite after a few weeks. Most attacks occurred on the playground or on the way home from school.

The girls were obviously taking advantage of the fact that Teresa was left on her own at school. The distressed girl dragged herself to school each day, hating every minute of it. She secretly hoped and prayed it would all end.

One fateful morning, Teresa was on her usual dreaded trek to school when she came to a highly trafficked road that she crossed on most days. On that particular day, she was not feeling very confident.

She hesitated when there was a break in the traffic, and that hesitation would soon bring the motor vehicles soaring down the road again.

She must cross and soon! The indecisive, hesitant Teresa crossed, but earlier than she should have. There was the screech of brakes and a firm knock to her fragile body, which threw her down onto the road.

Looking up, all she could see was the wheel of a car. Thank God those brakes worked, she would reflect several times in years to come.

That was a close call!

A very concerned driver and a few passersby came to her rescue.

Thankfully, no major injury resulted from the accident. Shaking like a leaf, Teresa was ushered into the nearby coffee shop, encouraged to sit a while to pull herself together and wait for any delayed reaction before being allowed to resume her walk to school.

I knew that walking on my own was not a good idea, she bemoaned as she continued on her way to school, the reality of the near tragedy beginning to come to mind.

In shock and still shaken, tears beginning to well up, grazes on her knees, and elbows beginning to sting, she walked into class late and explained to her teacher what had happened.

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After what seemed a long, tiring day (a waste in terms of learning), she proceeded to go home, taking utmost care when she came to that same busy intersection, the site of her recent mishap.

Some good did come from that near-fatal accident. Her parents made sure she was accompanied to school every day. Even Mum took time out from her busy schedule to walk her to school.

The new routine did not last long. Teresa’s sisters returned from boarding school at the end of that year. The bullying stopped, and life seemed to have regained a sense of normality.

Over the course of the next twelve months, it became evident that a career in nursing would be a choice option for eight-year-old Teresa. Coming face-to-face with that fast-moving vehicle was a watershed event for the girl because it prompted her to set a goal for her future. She regularly reflected on that eventful day when the many people at the roadside showed her care. She would like her life to take that direction, to look after the injured and sick. She tucked away these thoughts on the off chance it might just come true. The years rolled by, but her years at primary school would be a period of her life she would never forget.

The convent she attended was average. The manner in which the nuns treated select groups of students left a lot to be desired, and Teresa strongly believed that not coming from one of the wealthier families was an obstacle. As a result, she strongly believed she was subjected to unfair treatment, which caused added distress for the nine year old.

At eleven years of age, Teresa was struck down with the dreaded typhoid fever. The crippling illness meant that education would be interrupted while a strong course of antibiotics was administered in the form of regular intramuscular injections, as practiced in the mid to late 1960s. The two-month absence from school would create 7

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major gaps in the girl’s learning, especially math, and she gradually fell behind and found it difficult to catch up. The time away from the classroom during this formative period of learning would leave a phobia and a struggle with the subject. The more involved the topic became, that much greater the strife of trying to pass the subject each year.

Around the time Teresa attended senior primary, her parents split, much to the disappointment and anguish of the younger siblings. The embarrassment was also proving stressful. A split within an Indian family in the 1970’s was unheard of. Her mum began a relationship with another man, whom she was seeing in secret. Her dad soon found out, and as expected, all hell broke loose.

While her mum did not cut ties with the family, the impact of her actions was taking its toll on everybody. Even the older brothers were feeling the strain.

Dad stayed on and tried to continue his role in the family. The younger siblings went through a couple of harrowing years, while their dad was devastated and their mum, trying to prove that she was not abandoning the family. The children were torn between the two parents, and they struggled with divided loyalties.

While her mum seemed content in her new relationship, to the young girls, it seemed like she had jumped out of the frying pan and into the fire. Her new partner was not very friendly to the children.

He provided the much-needed financial help to the family, but he perpetrated sexual abuse on the younger siblings—Mary and Teresa in particular—leaving the two young ones with emotional scars to carry well into their adult lives. Teresa found it difficult to trust men and struggled to enjoy the intimacies and emotions that should come naturally to a healthy relationship. However, she worked through it with prayer and the help of books and other positive influences in 8

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her life. By the time she began the period of courting and marriage, she was able to overcome her dark past.

High school brought a change in terms of her being noticed by the opposite sex, even her brothers treated her like a young girl. The family seemed to have adjusted to the strange existence of Mum living away from home, and Teresa’s eighteen-year-old sister took on the role of managing the home.

Her dad, however, continued to struggle with the separation, which significantly impacted on his work practice. The family once again was facing hardships. To overcome the financial strain and with the intention of continuing their education, the now fifteenyear-old Teresa and her younger sister went to live with their older sister in Delhi. Immigration to the Western countries was a growing trend in the late 1960s. At around the time the girls left home to live with their older sister, Teresa’s older brothers began the migration process and left for Australia in 1969.

The family was moving on. The girls’ stay with their older sister was not what one would call a success. Teresa’s older sister had problems of her own. Her marriage was not a happy one. Despite her unhappiness, the older sister took a maternal role. She was caring and extremely attentive to the young girls.

After two months of going nowhere, the girls returned to Bangalore, where Teresa resumed high school. Due to the break, she was advised to repeat. That was the best decision. The sixteen-yearold was able to integrate, refocus, and consolidate.

As Teresa grew into a young woman over the next few years, she grew very close to her younger and older sisters. Her sister, who was older by two years, was now married. They would go places together, read books until late at night, and enjoy listening to Radio Australia. They were excited that their brothers were “down under” 9

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with their wives and families. At the time, music was the social outlet for young people, and Teresa and her siblings took the opportunity to participate in any social event that presented itself.

Church was also regularly attended, and it was seen as an outing for the girls. Walking, their chief mode of transport was quite frequently and light heartedly referred to as “legs eleven.� The time was used to chat as they strolled to school, church, or the shops.

Some mornings after church, they would stop to have breakfast at a restaurant. Nothing was more delicious than a hot masala dosa on a Sunday morning after church.

Seeing a movie was also a very popular form of entertainment.

The aim was to see the new releases, and this always proved to be a sound conversation starter. Lengthy discussions could develop from the simple experience of seeing a good movie. Despite the popularity of the Bollywood industry, the English movies stood out well in front; it was not uncommon to have the popular movies booked out for one week at a time when they were first released.

Dances were a seasonal pastime and proved to be another means of socialising. They were fun to attend and provided an opportunity to wear a glamorous dress, meet someone new, and have a dance partner for the night. On some occasions, serious relationships developed from meeting a person at the dance. At the end of one such dance, her partner at the end of the evening inquired of Teresa when he could see her again. Reluctantly, Teresa explained she was shortly migrating to Australia.

Life still remained tough for the family. The parents’ separation came as a sudden blow to the family, and each member dealt with it in his or her own way. Each outburst or conflict impacted immensely on the family structure and dynamics.

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It was a blessing when the opportunity presented itself for the remainder of the family to migrate to Australia. Teresa was sixteen when she went to Madras, now known as Chennai, to be interviewed by the High Commissioner of Australia.

In the months that followed, her older sister had delivered her first child, adding a pleasant diversion and excitement to the household, particularly after she moved back to live in the family home. Teresa relished the role of playing pseudo mum. The excitement of having an infant in the home defied all imagination when considering the miracle of childbearing and birth in itself! A teenager “gets it,” and the whole fertilisation process completely mesmerised her. Teresa threw herself into the role, and she was thrilled when her sister asked her to be godmother to the new baby.

Halfway through that year, much to her teachers’ disappointment, Teresa left school for preparation to migrate to Australia and chose to take on a post in the country, teaching English to kindergarten children while she was waiting for her visa and medicals. With hindsight, she should have completed her formal education before leaving India, as it did create a few hassles for her in the years to come; however, if she had done so, she would not have had the experience of teaching English to five-year-olds, an invaluable challenge. It was with a sense of achievement that, when she was about to leave India, some of the brighter students began to speak a few phrases in English.

The heart-wrenching time came when the obvious was evident that she was about to leave her mum and younger sister behind to migrate to Australia. Saying good-bye to her mum was one of the saddest days of her life. Teresa would later reminisce on the evenings when she would lie on her mother’s lap, and her mum would fondly stroke her hair at eighteen years of age. That precious memory was to last a lifetime. Several years later, when Teresa was stroking 11

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her twenty-seven-year-old’s hair as she lay on her lap, she reflected with intense emotion on that tender moment with her mother. The separation was intense and an enormous heartache. The young girl did not quite comprehend the major adjustment needed for the process of packing bags and moving to another country. With her dad and older sister by four years she left India in December of 1974.

Australia was vast. The big trucks on the highways were extremely intimidating. How would she survive in this new country with wide roads, big shopping centres, and everything so precise? From the sublime to the ridiculous, she thought.

It took a solid six months to settle in the country. Teresa knew she could not turn back, as this was her future. Australia promised a better life overflowing with opportunity, and it somehow seemed right to be here in this land of milk and honey. It was great to see her brothers after all these years. They were doing extremely well, according to Indian standards. They had saved enough money to buy their own homes and live the Australian dream.

Much to Teresa’s dismay and disappointment, Mary, her younger sister, remained in India. Teresa also missed a boy she had grown to like, but she was realistic enough to come to terms with the fact that there was no future in the relationship. The separation gave her an added reason to become melancholy from time to time. She soon realised she must move forward. She began to develop a strong relationship with her older sister and looked forward to having chats and quality time with the family.

Soon the process had begun for Mary to join the rest of the family. The excitement had become unbearable at the thought of meeting her sister again and having confidential chats and giggles as young girls do. Teresa never at any time took for granted the hospitality extended by her brothers and their wives. They were 12

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always attentive and made the newcomers feel at home. The many family gatherings assisted in promoting a positive outlook on life in a new country.

Initially, Teresa obtained a job in a local factory. She was not satisfied, however, and regularly perused the newspaper for new opportunities. One remarkable Saturday, while looking thorough the Sydney Morning Herald, she came across an advertisement that read, “Like to acquire a career in nursing?”

Wouldn’t I just? she thought.

She made a point of following through on the post. Not long after, she attended college to study, mainly subjects like math, English, and science. She conscientiously and eagerly participated in the six-month course, which included exams in each subject. Fourteen months after arriving in Australia, the now nineteen-year-old had the credentials to commence a nursing course. A dream at age eight became a reality in her late teens.

Mary arrived in October of the following year. Teresa had begun her entrance to nursing study, and took the course seriously. She would study for exams and as the year drew to a close the expectation and pending arrival of her dear younger sister was exciting. Life that seemed dismantled at one stage was heading in a more positive direction for the nineteen-year-old. The sisters would walk together to guitar lessons, have “shop ’til you drop” experiences, and enjoy some great family gatherings. Oh, it feels so good, Teresa often reflected.

Shopping for clothes was the highlight of the days to follow. There was much from which to choose, and the clothes were affordable.

Having a disposable income was certainly a special treat.

At the age of nineteen, Teresa met Martin, the man who would become the father of her five children. Teresa wanted to resume 13

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learning to play the guitar. One sunny day in late August of 1975, while strolling down the main street of a shopping centre, she stumbled upon a guitar studio. Her inquiry left her with the commitment to commence lessons. Three weeks later, guitar in hand, she walked into the studio, ready to begin. Excited about the prospect of beginning lessons and learning her favourite songs (“Mother of Mine,� for example), she sat down and introduced herself to her tutor. For the second time, the experience was of finally sitting in a guitar studio. Strumming or learning to strum on a guitar was rewarding. After going to the extent of cutting her nails (taking it seriously), she realised early that regular practice made a difference and improved her skills remarkably. Her guitar teacher, Martin, was very patient and pleasant. Initially, Teresa thought him a bit arrogant, but that perception was soon put to rest. The music was definitely a common link, and during ice-breaker conversations, she was surprised to discover that they had other common interests like cricket and Australian politics, an interest for the new comer.

Some days, when she put effort into her practice, the music sounded good for a learner. On one occasion, Martin took her guitar home and threaded the strings so she could play left-handed. She thought this to be a very sweet gesture. She liked Martin; in fact, she began to like him a lot, but she believed her feelings to be nothing more than a girl’s typical infatuation with her teacher. She decided that, when she completed her initial study to enter nursing, the best alternative would be to abandon guitar lessons and focus on the pending course. This move would allow her to integrate into a new career and concentrate on the unique practice of nursing.

One evening, with a great deal of enthusiasm and determination, she confided her decision to her teacher. She hesitantly explained that she would or might return to her guitar lessons when she settled 14

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into her challenging new role. She was not prepared for what would follow next.

To her amazement, his response was, “Are you free next Saturday night?”

She could barely believe what she was hearing. She expected that this chapter of her life, her relationship with Martin, would close.

Instead, she was now given the option to share a meal with this man, one whom she had grown to admire and respect. She loved his compassion for the less fortunate, his interest in the Theosophical Society and Annie Besant, and his vast knowledge of Australian politics, was extremely impressive. Furthermore, also, the fact that he was studying psychology meant he was interested in human beings.

Overall, he seemed a great human being. She would make sure she was free.

“Yes, I am free,” she announced. “That sounds nice.”

“I will collect you at six and call during the week to confirm.”

Phone numbers were exchanged, and a flushed Teresa walked out of the studio in a blissful haze.

Guitar in hand, Teresa almost ran the rest of the way home. She could not wait to inform the rest of the family about her upcoming date.

An almost breathless Teresa burst in through the front door and blurted, “He asked me out! He asked me out!”

The expressions on her dad’s and siblings’ faces reflected amazement to gradual amusement and, finally, real joy. All the family was under the impression that Teresa’s feelings were based on infatuation.

She was able to organise her work schedule in order to have the night off, the student nurse with, whom she requested to exchange the shift, said, looking at the plea in Teresa’s eyes, gave her no alternative 15

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but to agree to swap the shift so Teresa could have Saturday evening free. The evening was a success. Dinner was delicious and followed a performance by Dennis Walter Australia’s all time great Baritone.

His deep voice sang romantic songs, and they danced to some of the more popular ones. Teresa was loving the moment. The night ended almost as soon as it started. Chemistry was good between the couple.

They chatted a lot, and the night ended with a gentle kiss.

A date followed the next weekend, and it seemed like the two had the potential to develop a steady relationship. A few weeks later, Teresa learnt that Martin had enrolled to complete his undergraduate studies as a full-time student and, as a result, needed to discontinue teaching guitar. They would date until their educations had been completed. Teresa completed her nursing course, obtained a credit, and, as planned, married Martin two and a half years later, after that first date in the December of 1976. *** The nursing course was enjoyable, challenging, and hard work. The first six months were difficult; however, Teresa would periodically reflect on the fact that she was nursing, and with those thoughts, all doubts would vanish.

Most patients loved Teresa. Her caring manner and dimpled smile made her a winner. She totally loved caring for the sick, and she was a natural when it came to showing compassion and working as part of a team. She worked well on the wards, and her sound interpersonal skills served as an advantage in the workplace.

Frequently, she would feel extremely thankful for being able to fulfil her dream of becoming a nurse. She always appreciated that, at the end of a shift, sisters in charge at the time would quite often say, 16

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“Thank you.” This simple gesture conveyed a sense of appreciation and teamwork.

Sadly in 1981, Teresa lost her eldest sister and pseudo mum Antoinette to breast cancer, diagnosed eighteen months earlier, she passed away with no family by her side. When Teresa visited India in 1980 with Martin, disillusioned with life, she expressed a lack of interest in surviving the illness. At 42 yrs of age it was a sad loss to the family.

Almost two years later, In 1983, not long after the birth of her first child Vivien, another blow to the family, when her mum had a sudden Heart Attack and passed away, at the age of 64 yrs. Teresa left her ten month old baby and flew to India to pay respect to the mother sadly she did not have the chance to bond with like most children. Being at the funeral, brought some closure to the strange relationship she had with her mother. The sudden loss was deeply felt by all family members. Each person dealing with the loss in his or her own way. The untimely death, would become a water shed moment for Teresa; she will never take life for granted.

On the home front, married life was proving a success, and it was even more satisfying when a family was started. The couple moved to a small property on the outskirts of Sydney, and Teresa stopped nursing to become a stay-at-home mum. Five years later with three children, five, three and eight months old, she returned to the workforce. She blossomed during this time of her life. She was very content with her young family and enjoyed being back at work.

This feeling was expressed to a patient when she said one day, “I am really satisfied, with where my life is currently at, I could not ask for any more.”

Teresa continued to work and had two more children. The couple finally scored a son. This brought great joy to the family. They loved their four girls; however, the family seemed complete with the birth of a son.

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As one night supervisor said to her, “Every mother needs a boy.”

There was sheer joy in the little country hospital where she worked. When her baby boy was born, it was no surprise when it was announced over the intercom, “Teresa has had a baby boy.”

Later that evening, she made a trip to the nursery just to make sure that she actually had a son.

Life was very busy with five children under the age of ten.

Despite this, when her boy was ten months old, Teresa decided she must attempt some further study and seek to specialise. Cardiology would be the area of specialty she would choose. She always had an interest, as she lost her mother to a cardiac illness. She continued to study and gradually worked toward completing sufficient subjects to earn a master’s degree in cardiac nursing with a sub-major in critical care. Her husband was a legend and supported her through this challenging time. She knew that, without his encouragement and support, attaining this goal would have been impossible with children ages two to twelve years old.

As life would have it, Martin was offered a senior position with the Department of Education, disrupting the status quo. Demands on his time were high, and teenage children were proving to be a challenge.

Teresa’s job was highly stressful as well, and she worked around the clock some days when patients had heart attacks outside of hours and she would be called in to join the cardiac team as they performed procedures to open up closed arteries that supplied blood to the heart. She knew she must press on. Studying was crucial to bridge the gap between college and hospital nursing. All commitments needed to stay, as they were a necessary, pragmatic evil.

The loss of her father in 1996, from a bleeding esophageal ulcer, at seventy-seven years of age came as a blow to the family, and four months later, the loss of her brother to a Heart attack at 57yrs of age.

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Not sure where to turn to for help, she soldiered on. When her sister was diagnosed with a brain tumour, Teresa believed that unexpected events must come in threes. The family losses were life changing.

Through the challenges, Teresa battled to raise her family, working and coping with her grief at the same time. Finally, she was treated for depression. She put her study on hold while she battled to juggle what life was throwing at her at the time.

At a professional level, Teresa began to see an unfortunate change in the field of nursing. Staff members were not able to relate to each other or to be committed to the profession. Personally, she found that certain staff showed resentment towards her, a behaviour she was unable to understand. It seemed like the fact she was studying did not sit well with some staff. Attitudes were subtly indifferent. She worked through various specialties in cardiology, and certain behaviours she experienced would have horrified nurses and managers from her past.

Over the next few years, it became obvious that the health system was in disarray. Decisions were based on bias, jobs for friends, inconsistencies, cover-ups, and workplace wrongdoing. The new system was a whole world away from the seventies and eighties when nursing was straightforward and simple. Frequently, Teresa wondered in which direction the profession was heading and what its future held‌ if any!

It became apparent through the mid- to late nineties that a pattern was developing. Titles were given to nurses with remuneration benefits as a way to recognise experience and education, a good move.

As a result, management restructuring took place. This major change would assist in the improvement of the nursing practice, introduce research, and develop leadership of staff. This was an excellent path for nursing to head in; however, the downside was—and is—that 19

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nurses were not prepared for the true responsibilities and challenges associated with leadership. Furthermore, as is the case with all major restructuring, safety nets had not been set in place.

Marginalisation developed within the profession, and misuse of power began to surface. Should that power be placed under threat, then be prepared for the house to come down like a ton of bricks. To be belittled, intimidated, harassed or confronted in an unprofessional manner became common practice. Furthermore to perpetrate coercive behaviour towards the person who was fragile, vulnerable, experienced, or educated was common practice. As always, with progress, come setbacks in other areas. It seemed like the nurse at the forefront, the one caring for the patient at the bedside became the loser. The dirty little secret began to develop within the profession.

The bully demon had entered the system, and sadly, Teresa soon became a victim of this pattern of abuse. Through the latter course of her career, she would be subjected to several instances of bullying, abusive phone calls, and confrontation, which began to place enormous pressure on her at work and in the home. *** The next few chapters narrate Teresa’s story of bullying, it draws attention to the very real problem of bullying and its consequences.

The literature determines its existence and argues that it is becoming a growing concern for organisations, parents, employees, and governments, alike.

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CHAPTER T WO

The Bully Unmasked

2.1 What constitutes a bully?

Based on much research (Cowie, Naylor, Rivers, Smith, and Pereira 2002; G. A. Farrell 1999; L. U. Farrell 2002; Hoel, Faragher, and Cooper 2004; Keashly and Jagatic 2003; Quine 1999), the attributes, frequency, duration, and degree of bullying vary, but the crime generally encompasses overt and covert behaviours such as those described below: • • • •

•

Hostility, dirty looks/gestures, curt tones of voice, condescending treatment, and deception Enforced isolation and exclusion from important meetings and withholding of pertinent information Downplay or denial of the bullying Inappropriate use of authority, excessive monitoring, nitpicking, and pressure to discourage application for employee benefits (sick and/or conference leave) Intolerance 21

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•

•

Harassment, repeated reminders of errors and mistakes, intimidation, creation of false or exaggerated incident reports, attempts to engage others in the bullying, gossip, spreading rumours Defamation, lying, name-calling, and questioning of the nurse’s competence

Behaviors are perpetrated by the bully causing great distress to the person on the receiving end of a harsh tongue, mean mentality, and coercive pattern of conduct.

Complex and ethical dilemmas in the workplace regularly confront the health professional. Some staff undertake the issues head-on, while others turn the other way; consequently, the work environment can become a challenging, insecure place in which to work (Glendinning 2001; cited in Haselhuhn 2005).

The humane and caring aspect of the nursing profession, will always stand out as a culture designed to practice from the heart; however in reality, those accolades contradicts all elements of true practice. Radcliffe (2009) disagrees with the caring reference when he compares the profession to “a person given a head massage followed by a contradictory blow across the head” While that analogy is extreme, the fact remains that, when it comes to harming each other, as a culture, nursing would have to top the list in terms of disloyalty and backbiting.

The average person enters nursing with dedication, a commitment, and an eagerness to fulfil the all-time dream of optimum care and best health outcomes. Unfortunately, quite often, they are shattered by the experience of hard-core nursing, strengthened by the impression that, if a nurse stumbles, she or he will be pushed right over.

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Terms such as “Nurse Jones is being targeted” or “the smiling assassin” commonly describe the intimidating or bossy nurse. Across the globe, it is referred to as a culture that eats its young. Some argue that, as members of a caring profession, nurses want little to do with caring for each other. Bizarre as it may seem, in reality, nurses are leaving the profession in droves, and unless urgent attention is given to the circumstances, the sick will have fewer and less experienced nurses caring for them, resulting in medical errors due to stress, anxiety, and workplace chaos (Jackson, Clare, and Mannix 2002).

2.2 Literature The literature states that most new graduates survive a maximum of six months in their first nursing placement due to unreasonable demands, high expectations, and a lack of support or mentoring during that critical time within the first placement.

However, intimidating behaviour is not reserved for the new recruit. Basically, anyone vulnerable is targeted. The experienced, educated nurse is seen as a threat, the popular nurse is envied, and even the nurse who is hardworking and credible can be frowned upon by colleagues who lack some of these attributes. It appears as if the Bully’s actions are intended to put victims in their place and render them dysfunctional or attempt to create a platform of nurses with set personalities and conformists who will do as they are told; a subtle form of dictatorship.

The new recruit can often provide a breeding ground for bullying, particularly if it is a new area of work practice and the graduate is dependent on learning new protocols and policies, or even use of equipment, as is the case with specialised areas. Impatience, 23

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intolerance, withholding of information, lack of supervision, and rudeness are practices that start to create an extremely stressful and uncomfortable environment, marked by the experience of a degree of helplessness and a lack of job satisfaction.

Roy (2007) refers to this situation as a “silent killer” and advises that it has slowly eaten away at the core of “who we are as nurses”; furthermore, he points out that new graduates comprise the group of most frequently victimised.

It comes as no surprise that, without explanation, nurses can be thrown into the deep end with the clear expectation or warning that they either sink or swim. For example, when Teresa was clearly having problems coping with her workload, instead of attempting to put constructive strategies in place to help, she received rude emails and nasty phone calls from her manager, making her feel incompetent. This added to a further decrease in her productivity and an increase in her stress levels.

Intimidating and undermining behaviour, coercion, confrontation, professional sabotage, scapegoating, and finger pointing can become common practices for placing an enormous amount of pressure on the person. In some instances, the persons being bullied may expect abusive phone calls, nasty emails, and devious behaviour designed to devalue or keep them out of the loop. The mentor, in the true sense of the word, virtually does not exist The idea of taking recruits under their wings and guiding them until they are able to cope is almost unheard of across the nursing board. Instead, the culture encourages intimidation and creates a fear that permeates the workplace, making it an uncomfortable and unfriendly environment for new recruits and seasoned nurses alike.

Stevens (2002) highlights the fact that, of forty-three thousand nurses surveyed throughout five different countries, fewer than half 24

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were satisfied with the way in which nursing administration listened and responded to their concerns. This statistic, is an unequivocal confirmation to the fact that nursing administration in terms of listening and responding to concerns in a satisfactory manner, is a global issue.

Brown (2010) aptly asked the question, “Why are nurses so mean to each other?” For this reason, the author emphasises that the issue of bullying needs to be publicly acknowledged and discussed.

Nurses who are assertive or possess the moral courage to step out and advocate for a staff member or a patient can expect adverse outcomes (LaSala and Bjarnason 2010). Staying clear of the conflict is the wisest move. In fact, it is in a person’s best interest to support the perpetrator. Being in the good books (being in favour with the boss) is a good option, given the fact that most bullies are leaders, and aligning oneself with them could make life less complicated considering they develop rosters, allocate workload, and basically have the power to make life quite miserable or pleasant.

Recorded and reported incidents of unreasonable expectations and demands bring to the forefront the firm belief “that nursing is not a profession of understanding nor one of looking after its employees interests.” Leymann (2012) asserts the importance of implementing moral reasoning and courage in the role of nursing. Therefore, it is imperative to develop these characteristics of moral reasoning and bully awareness throughout nursing school and advocate them as a project for improvement.

Brown (2010) applied the argument to reality when he discussed the response given to a nurse who was unable to hand in her assignment due to hospitalisation for kidney stones. Despite a doctor’s note, her nurse manager told her that she should make better life choices.

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Teresa had a similar incident. One morning, when she had to take her eleven-year-old son back to the doctor due to a relapse of pneumonia that had occurred overnight. As a result, he needed a repeat chest x-ray. Her manager Viola told Teresa that she would not be given time off again, as she needed to be better organised and should have given more notice about having the time off. This lack of empathy and understanding highlights the fact that senior nurses need a high level of training in diplomacy, governing, and objectivity. Just as clinical nurses have mandatory training, so should nurse leaders. Incivility in the workplace is costly, both financially and emotionally, as it predisposes professional nurses to absenteeism, burnout, and departure from the workforce (Murray 2008).

Jan, a nurse practitioner, adds to the argument in Brown (2010) by pointing out that it is a gender issue and emphasises that the bullying is a portrayal of how women in the workplace treat one another.

She confronts the subject by arguing that women are backstabbers, viciously competitive and envious when it comes to our gender.

Instead of celebrating success in the workforce, we sabotage and alienate those who strive to accomplish great things in our careers.

Teresa found this to be the case in her career progression, particularly while she was studying to complete her masters degree, the incivility she experienced at times were extremely destructive.

In some instances, she seriously considered not disclosing that she held a postgraduate qualification. In a tell-all discussion during a dispute, her manager falsely accused her of unnecessarily “flashing her qualifications around.” The accusation distressed Teresa to the extent that she was unable to function in her role for quite a while.

Teresa had taken on her secondary education to prove to herself she could do it, and very early on, she realised that talking about her qualifications was like “waving a red rag in front of a bull”; therefore, 26

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she steered right away from the subject and remained modest about her past education.

Brown (2010) adds to what Radcliff (2010) says when he destroys the myth that nursing is a caring profession and reveals, “Almost without fail, those nurses who are abusive to their co-workers are in it for the money. They are less supportive, are least engaged with training new staff and are the most defensive people to meet.”

Whatever the case, Teresa’s experience was not pleasant. She found that the managers seemed to be insecure micromanagers who went to the extent of undermining any contribution made by her, keeping her out of the loop, talking behind her back, and manipulating situations to make it difficult to the extent of not granting annual leave.

This type of attitude can be destructive and influence several areas of a person’s life. The experts state that depression sets in, exacerbated by insomnia, irritability, a lack of concentration, and focus. After one horrendous meeting, Teresa drove through a red light on her way home and almost had an accident furthermore she was brought back with a jolt when she could not remember most of the trip home.

Instability within the profession in terms of staff shortages, heavy workloads, and ineffective managers encourages a culture of bullying behaviors, this attitude adds fuel to fire and prompts nurses to leave their positions or to take alternative career paths.

The Australian Bureau of Statistics (ABS) stated that, between 1986 and 2003, there was a 22 per cent decrease of nurses working in aged care and an 8 per cent reduction of nurses working in hospitals.

More than likely, the numbers have decreased further in 2012. At one time, the New South Wales (Sydney Australia) government was considering introducing a number of initiatives to retain nurses when health care collectives seriously considered rewarding those 27

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nurses who stayed within the public health system for a period of ten years. Despite the possibility of a reward, nurses continued to exit. The issue of bullying and imbalanced work practices obviously needs to be addressed as a matter of urgency. Serious ramifications will result if the current trend continues. Nursing and all it stands for, historically, will be crippled. The shortage will reach critical levels and cause a dismantling at all levels within the health system as it is a well known fact that nursing is the lynchpin to the health system in hospitals.

The literature clearly indicates that the issue related to nurses exiting their profession is not necessarily one of remuneration, but one that is related to the nature of a system grounded in a culture of stress, an attitude of blame and lack of support. Heavy workloads, imbalanced task allocation, and the total absence of support by senior managers will continue to deteriorate a profession that is already in disarray.

A review of the literature highlights the fact that, in general, nurses across the board believe that the profession is in chaos. One nurse educator points out that experienced permanent nurses are leaving the profession and being replaced with junior or trainee nurses. The new recruits are in no position to run a ward or clinical area. They in fact need clinical support and supervision rather than unnecessary responsibility, the senior nurse alerts to the fact that the scenario naturally impacts staffing and patient safety. With insufficient senior nurses, juniors are thrown into the deep end, and patients are at risk. Therefore, the ball is in the court of middle and top management. They need to be aware that underpinning the nursing structure are the workers at the bedside, where most of the frustration originates and is experienced. Hence, fair practice, understanding, 28

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and flexibility are of utmost importance for job satisfaction and selfworth if nurses are to be retained in the profession.

Miller (2011) carried out a survey on job satisfaction within the nursing profession. The outcome results were interesting—however not a surprise—and could have been predicted by some nurses. Of 612 staff members that were recruited, 59 per cent admitted to having regular staff meetings, a low percentage for a highly skilled workforce.

A disappointing statistic as an open forum is the place for change, it is seen as a platform where staff can voice opinions, make suggestions, and have discussions about issues and practices that need scrutiny.

Furthermore, it is an ideal setting for reflection and trashing out differences of opinion. Regular staff meetings help to improve practice and review mishaps and incidents that occur within a clinical area. As expected, the author reports that 38 per cent of respondents reported high levels of burnout and stress; the outcome of overwhelming levels, of unreasonable, dangerous and heavy workloads.

Nurse researchers Woelfle and McCaffery (2007) speculate that nurses attack their own because they lack autonomy, accountability, and control over their profession. They point out that this can often result in “displaced and self-destructive aggression,” a confronting scenario.

Ultimately, nurses need to be the catalysts of change (Roy 2007). They need to recognise the condition of the profession and the consequences if the current climate continues. Seriously, the bureaucrats need to be proactive in fixing the problem. They should listen to the majority of those who are leaving and are prepared to speak. Promotions should be based on ability, experience, and knowledge, not bias. An honest approach needs to be taken for the progression and development of the profession. When that stand is made, the nursing profession will move in a positive direction.

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2.3 The Nature of Nurses / bullying a breeding ground Nurses in general are not militant by nature. Their dedication and commitment to caring for the sick is instrumental in developing a passive, compliant personality. This quality has proved to be a hindrance more than an advantage. As a result, it has provided a breeding ground for unfair practice, deprivation of natural justice, malpractice, and bullying.

The pattern of bullying and intimidation is a top-down practice.

Managers support each other and, unfortunately, nurses at the bedside are the losers. They (nurses) are under strain, and they work hard to face stressful circumstances on a daily basis. They are forced to work in unreasonable conditions, and many go home to young families. They need positive feedback, should be spoken to in a civilised manner, respected, and valued as professionals. They should be consulted, and their opinions should be valued. A diplomatic approach goes a long way in getting a person to perform a job.

Positive reinforcement always works. For recruitment and retention to be enhanced it is essential that there is in addition there ought to be an increased awareness and understanding of the problems faced, the major effects of shiftwork and the physical and psychological implications of working in a nursing environment. In order to create change, these facts must be addressed, and emphasized. However, despite the fact that almost every nurse has been through the mill, some will carry out similar abuse in areas in which they themselves have struggled. It appears like there is an intrinsic awareness of exactly where to exert their power and manipulate practice to place maximum pressure. This makes the premeditated behaviour more malicious, hurtful, and destructive.

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It is imperative that senior management play an important role in participating in training and development. Change must come from the top. Managers need to constantly attend seminars. A company or organization, with the philosophy of mandatory courses, for leaders, zero tolerance to bullying, compulsory reporting, scrutinizing adverse behaviours and one who encourages mutual respect will be seen as worthwhile to work for. Just as hand hygiene is advocated and advertised widely in all clinical areas, So also should bully awareness.

When this practice is taken seriously and adverse behaviour is discouraged, change and a turnaround will emerge as the harmful practices experienced begin to reduce through mindfulness.

2.4 The Right Job To obtain the perfect job, is almost unheard of, and rare to find, however doing some research into employers and their work culture can be invaluable.

In the long term, seeking and obtaining the right job can prove extremely beneficial to the person looking for employment.

The mental anxiety and distress as a consequence of working in an unhealthy environment can be avoided by taking the necessary measures to as far as possible to obtain the right job. Research on the organisation, the managers and staff, in general, can be of great advantage, and value, knowledge of the prospective frontline manager can prove to be useful. She or he will be the one who will roster nurses, provide all workload, and always be in the perfect position to practice coercive bullying, micromanage, and perpetrate unpleasant behaviours to cause anxiety.

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If a fellow colleague says that Joe Brown runs a tight ship, one immediately thinks, “Micromanager! Stay clear!” The consequences of working in that environment can be far worse than not having a job. These managers always want to look good, even if it is at the nurse’s expense. While on a rostered day off (RDO), they may send spies to make sure nurses have not taken too long for their breaks or call close to the end of the shift to check whether they have gone home early. Nurses who take sick time may expect a phone call and then a quick hang-up to make sure they are at home.

Pursuing a job can be a challenging process. It requires a lot of preparation, research, and the right mind-set to interview an employer just as acutely as the applicant is interviewed. Furthermore, should one feel confident that he or she has the ideal skills and knowledge for the job applied for, then every effort should be made to place a prospective employer under the microscope.

Kate Lorenz (2008) refers to the importance of personal qualities, habits, attitudes, friendliness, and social graces when searching for the right job. Very often, just walking into these environments provides an immediate insight, of whether the workplace is a happy content environment in which to work. Employers possessing sound interpersonal skills make for pleasant workplace settings. The author confirms the well-known fact that nurse leaders are the protagonists in fuelling conflict and creating an unpleasant work situation, as is the case with all other organisations in which leaders play an important role within the workplace culture. Hence, be on your guard when at interview. Perusing a prospective work environment can be a stepping-stone to contentment or sheer anxiety. *** 32

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Teresa would have saved herself unnecessary issues if she had taken this approach with a couple positions that she subsequently accepted.

After obtaining the role, she soon realised it was not all it was made out to be. While it seemed rewarding from an educational and primary health perspective, she found herself subjected to bullying.

She was spoken to abruptly and left with minimal resources on some occasions. The position was new to her, and her strong, extensive experience made little difference in terms of the treatment she received. At the risk of being paranoid, she believed experience and her qualifications were hindrances rather than an advantage.

The concept and structure of the job were different from her previous roles. Managers evidently used this to their advantage to be bossy, treat her as if she knew little, exclude her from important workplace situations, withhold information, and keep her out of the loop. Any attempt to contribute to the role or decision, making was either rebutted or ignored.

The job on offer for two days a week resulted with a workload as heavy as four days a week. Despite a warning from a (soon-to-leave) colleague about the heavy workload, Teresa chose to give the role a try. The consequences would change her life forever.

Two days a week, she was expected to run a busy chronic disease program at a small beachside hospital, travel forty minutes to perform administrative duties (75 per cent of the job) to another facility, share a computer at this hospital, store files, phone patients, and type letters to general practitioners. In addition, she was expected to carry out the clinical aspect of the role: screen patients, educate them on health management, and accomplish home visits on those patients who met set criteria. To exacerbate the time factor, once a month, she travelled nearly two hours from her work base to attend a staff meeting at the 33

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major hospital. This activity took a big chunk out of the day. Two days a week was not sufficient to perform the duties required. She found she had to prioritise.

With lack of support from management, she began to fall behind in the job over a period of six months. When she requested help from a colleague, she was denied assistance from her team leader Agnes, the reason being that the colleague was not the right person to help. With the absence of other help, she continued to carry on, prioritised, and rationalised that caring for the sick elderly patients was of utmost importance. Administrative work began to fall by the wayside.

On one occasion, Agnes came along to provide some help.

However, her manner was so stony and abrupt that Teresa wished that she had not come at all. It took a few hours to recover, and the visit resulted in unproductive work time. Teresa began to fall further behind and became less productive in her own work. She often reflected on the way she was spoken to or the lack of appreciation she received from management, especially Agnes. She continued to struggle to get through her work and opted to complete some tasks at home. The situation spiralled up a notch when she began to receive abrupt phone calls and nasty emails. This placed further pressure on her and resulted in even less productivity. She strived to see all patients and to provide an educational and supportive model of care.

Administrative work was behind, nit picking began, and mistakes were made. Some errors were genuine, while others stemmed from lack of time, resources and even sabotage became Teresa’s suspicion.

One such incident was the fact that accurate pathology values entered into a database by Teresa was altered to reflect incorrect values, the data was accessible to a team of nurses across five hospitals and leant itself to interference. Mysteriously pathology results (values) changed.

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While there is the element of human error, the level of inaccuracies were bizarre and unexplainable Teresa had no alternative, but to conclude that she was a victim of professional sabotage. Teresa strongly believed, that some errors, she was not responsible for, and had a hunch that values were changed to make her look incompetent.

In hindsight, Teresa should have looked at the workload and resources available to her before she took on the role. She would then have concluded that the job was not for her, as she would not be able to perform her duties with limited resources. Despite the comment by a vacating colleague about the workload being heavy and messy, Teresa decided to take on the role.

At the interview, it seemed that her prospective manager would be supportive and prepared to help. She expressed awareness and understanding that resources were slim and time was tight. It was reassured that help would be provided to run the very demanding chronic disease program. In good faith, Teresa thought she would get support and help. When she was unable to deliver the goods due to lack of resources, support, and time, management castigated her as an unsatisfactory nurse.

The other job, which was an adjunct to the chronic disease job, was initially a seconded (maternity relief) position for about twelve months. All was not right when following the interview, her manager phoned to offer her the job and demanded she resign from her permanent position. Teresa felt uncomfortable with this expectation and should have seen the warning signs. Instead, she accepted the role but made the wise decision not to resign from her permanent position in intensive care. She soon found out that the person for whom she was working was obsessively controlling, a micromanager who was difficult to work with and unable to please.

However, she liked the job, the patients, and the many allied health 35

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professionals with whom she had contact through the position, so she persevered in the hope that the circumstances would change.

She went one step further and when she was offered the position as permanent part time, twelve months later she resigned from her permanent ICU position; and stayed with her controlling manager and a job she liked, a move she would regret. It was not uncommon for the manager to nit pick, speak abruptly in the presence of others, or be subtly coercive and intimidating.

Signs always appear to give one an idea of what prospective employers are like. It is important to take note of these indications and seriously consider whether it is worth one’s while to take on the position or whether it would be better to look for another role. Again, in hindsight, Teresa should have stayed on in ICU to improve and expand her clinical skills. Instead, when the time came to complete her secondment and return to her original position, persuasion and encouragement softened her to stay, and she made the grave mistake of resigning. She overlooked the hard times and stayed on. The bullying continued, the circumstances got worse, and she stayed far too long in the job. The longer, in a difficult job, the more severe are the resulting scars and emotional damage. Therefore if a harmonious, problem free workplace is desired, it is of paramount importance that some fast track decisions are explored when facing difficult workplace situations.

Two positions acquired between 2003 and 2004 at two different facilities would cause Teresa many problems in the time to come.Â

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2.5 The Office The main challenge initially in the job was running a busy chronic disease program with the absence of an office base on site. The clinical aspect of the job involved screening patients, providing them with knowledge and understanding about their disease, and playing an active role to prevent recurrent episodes of acute attacks. The goal was, to reduce hospital readmissions and empower patients to control their symptoms and thus improve their quality of life. Home visits and phone calls were introduced to monitor progress or setbacks, the process was completed with letters written to the patient’s medical practitioners to alert them of the admission the diagnosis and the care provided in hospital, both nursing and medical. The success of the program depended on how many patients were reached or screened and the level of readmissions of those patients who were initially educated or followed. Reduced readmissions, was seen to be cost-effective. The rationale was that, if patients were educated to manage their chronic disease, there would be reduced rehospitalisations, and patients would be able to self-manage their illness. As a result, it would reduce the financial drain on the hospital system. The program was viewed as being very logical and forward in thinking. However, when it came to the mammoth task of data collection, like filling in forms and then doubling up and entering that information into a database, the process was skewed. Setting up files, filling in forms, and searching for data in thick medical files led to an immense amount of manual hours spent doing administrative work and less time spent on the real need, educating patients to reduce hospital admissions.

Teresa knew that, in working only two days a week she needed to work efficiently, hence it was imperative for her to have an office 37

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on site. The time wasted travelling to the sister hospital to perform administrative work, could have been used to screen and educate patients.

A letter written six months into the position to the director of nursing resulted in her acquiring a desk to share with the seamstress located at the back of the hospital. This arrangement while not adequate, provided the convenience of working onsite. It was not until four months later that she acquired an office. Continuous requests and complaints about not having a suitable office to Viola the manager ended in unchanged circumstances. It was not till a manager of higher authority intervened to advise the director of nursing of the situation, that a suitable office was ascertained. Not long following the discussion a designated office with a phone, computer, desk and filing cabinet was established. It took up to twelve months into the position to set up the practice as it was intended.

In the meantime, patient admissions continued, generating more administrative work.

Teresa was finally settled. However, by this stage, the program had gradually fallen behind, and there was still the refusal to allow a colleague to help get things in order. There was a lot of catching up to do. She also struggled with a fairly old and troublesome computer.

She was surprised and disappointed when all her colleagues at other sites were provided with new computers while she was left to cope with countless breakdowns, waiting on technicians to carry out repairs and left in the lurch to manage alone. She had close to no working relationship with her manager, Viola, and Agnes, team leader so she had minimal confidence in raising the subject of a new computer with them. Teresa believed this was a subtle way of making her life more miserable. The several incidents of computer breakdowns left her further behind in her administrative work and 38

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provided her bullies with more ammunition to use against her, and so it became a vicious circle. Effective and quality resources are required to get the job done.

Around this time, Agnes visited the site in Teresa’s absence.

Teresa received a phone call while at her other job, Agnes accused her of being behind in her work and saying her completed work was not in order. Fifteen minutes of berating and undermining threw, Teresa into emotional distress. She tried to explain, but to no avail.

A volunteer present in the office with Agnes at the time of the phone call raised concerns with Teresa’s office buddy at a later date about the manner in which the phone call was conducted.

She said outright to Teresa’s office buddy “I would not even talk to my dog like that.”

The call distressed Teresa to the extent that, she struggled to get through the rest of the day in her alternate role.

Abusive phone calls and emails continued. The lack of constructive help hindered Teresa from working effectively in the role. Viola or Agnes would not visit the organisation and offer constructive advice, such as, “Let’s see how we can overcome this situation… What can we do?… How can we help?” The manager’s attitude was always one of blame and abuse.

To exacerbate the downturn of the heavy workload, three months into the position, the only administrative person who helped to some extent left and was not replaced. Adding fuel to the fire, a more complex database was introduced, and staff were expected to access information from files to enter up to two years of backdated data for up to three hundred patients in addition to performing their regular duties. What was the rational for entering back dated data? Teresa found the scenario difficult, particularly when resources were slim and time scarce. With the excess amount of work and the 39

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introduction of a new database in the absence of adequate training, errors began to surface. In the wake of errors, eighteen months after the data base was first introduced, it was decided to provide a training afternoon, “better late than never.�

The impact of working only two days a week (unlike the other nurses) meant that it took effort to part with relevant information and as it turned out she was always the last to find out of changes or left completely out of the loop. The lack of training on the database made matters worse, she began to fall further behind, unwittingly creating a breeding ground for additional bullying, intimidation, and harassment. Abusive phone calls and rude emails regularly came her way, and she was not able to give her best in terms of working on the job. However, in an effort to prevent patient readmissions, she prioritised and kept in contact with patients endeavouring to maintain education, and follow up phone calls to avoid a relapse and trigger an acute onset of their medical illness

2.6 Lack of Autonomy All professionals are authorized to inherit some form of autonomy by way of training, education and development. Their study sanctions for them, a validity and credibility to practice. However nurses are denied this form of natural justice and Teresa was no exception, self directed practice was removed from her when she aimed to educate those elderly patients who were discharged with an advanced directive, not for resuscitation (NFR). She was told she should not educate these patients or teach them to manage their disease. Because of criteria mandating that patients who came from nursing homes, be deprived of education and support, the same situation occurred 40

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with a seventy-six-year-old patient who presented to hospital from a nursing home, was capable mentally and physically. While the acute onset of the medical condition reduced his ability to some extent, cognitively he demonstrated a sound capability. Teresa felt she had a moral obligation to educate this man in order to equip him to selfmanage his condition. Agnes was not happy and confronted Teresa, saying she (Agnes) would not have educated the patient and Teresa should have taken the same action. Teresa was in a moral dilemma. If a patient needed support, she felt it her duty to give advice, particularly if it meant preventing readmissions and improving quality of life.

Three months later, she was accused of incidents that occurred in her absence. The situation became extremely confusing and difficult to manage. She became less productive at work and at home. She was unable to sleep at night. She was irritable with her family and experienced a loss of appetite. It was not long before depression set in. She visited her local doctor, who prescribed antidepressants.

She began to prioritise. The focus of the program was readmissions, and she was successful in preventing them. However, she was falling behind in administrative work. I must press on. I would get through this. Help would come! All the backdated data needed to be entered as well and needed urgent attention.

2.7 The Event One winter’s day on Friday, while at her other job, Teresa received a phone message from her daughter, explaining that Agnes (Team leader) had phoned her chronic disease work phone which was at home and left a message with her daughter Tina. The curt message 41

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was that she (Agnes) would visit Teresa’s worksite after the weekend.

Bewildered at the choice of date and manner by which the message was left, Teresa decided to return the call that evening. She left a voicemail message requesting Agnes to either return the call to discuss the convenience of the visit or find an alternative day. Teresa briefly explained in the voicemail, that the site would be quite busy after a long weekend. The unusual demand, perplexed Teresa, she strongly felt that the team leader above all others should be well aware of the circumstances within the hospital after a lengthy break.

Furthermore she was unable to comprehend the absence of a valid reason to visit the site, in addition several attempts to contact Agnes was unsuccessful, the neglect to make contact meant that the matter was unresolved, as far as Teresa was concerned. She decided she will have to cope and manage the situation, the best she could, when Agnes arrived.

After a very restless weekend and especially Monday night, Teresa went to the office on Tuesday. At eight sharp, Agnes appeared.

She was hostile, abrupt, and ready to start conflict.

She said, “I am here to see how you work.”

Teresa explained that she was really not prepared and went on to point out that there was a lot of following up with patient referrals after the long weekend. She gently added she tried to contact her (Agnes).

The curt reply was, “Well, I am here, and I am going to watch you work.”

The threatening manner, intimidating behaviour and body language began to gradually anger Teresa. She had already had little sleep and worried about the day to come. How would she handle this person standing over her and demanding to look at her work?

She was really not prepared for this; furthermore, there were several 42

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admissions over the weekend, as often happens during the winter when the fragile elderly find it difficult to be compliant with diet restrictions over holidays or weekends, causing winter to be a busy time for nurses and doctors who care for patients with chronic medical illness.

She began to reflect on the tone of the message relayed from her daughter, the unprofessional way in which it was conveyed, and the neglect to return the phone call or acknowledge the message. She was not impressed at the way the whole incident was handled. In her opinion, there was evidence of rudeness and a clear lack of respect.

This is not fair, she thought. Anger began to replace her initial fear and anxiety.

Teresa began to change her tone, trying to be as assertive as she could while explaining to Agnes that the day was particularly unsuitable. She told Agnes that it was unreasonable to expect a review of her work following a long weekend; furthermore, she repeated that attempts were made to contact her (Agnes) to no avail, the frustration began to surface as Teresa continued nervously in fight mode. She reminded Agnes that she had given little notice and had chosen to ignore Teresa’s voicemail about the inconvenience. Clearly, she had little care about Teresa’s circumstances or welfare. Teresa asserted that her communication was inappropriate and unprofessional, and she went on to point out that some mutual agreement about this visit should have been attained before the day. She reminded Agnes that she, more than anyone else, should be aware of the heavy workload after a long weekend.

She blurted out, “I am really not prepared for what you are proposing.” Deciding to dig in her heels, she went on to say, “Today is not suitable for me. If you had returned my call, we could have talked.”

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Agnes replied, “Well, you will hear more about this,” and she stormed out of the office.

Hands clasped close to her face in utter disbelief at what had just happened, Teresa sank back into the chair. She felt nervous and timid, and she was shaking with anger, anxiety, and numbness. She pondered over Agnes’s approach, which had been unnecessary and not constructive. The intent to confront and play big brother did not sit well with Teresa. Agnes’s manner and attitude, from the time she had walked into the office, had been to use power, to intimidate, and to threaten. Teresa’s sleepless night was taking its toll. She would not survive being micromanaged by this bully for a couple of hours, furthermore she did not want the day any more stressful than it had already had been. It would ruin the day. Given the history of the last couple of days, Teresa had no choice but to refuse the visit, a decision she made to preserve her sanity. Had Agnes been more conciliatory, they might have been able to work together, but not under these circumstances.

The phone rang, and Teresa’s heart skipped a beat. Reluctantly, she answered. It was her line manager, Viola. Teresa was not surprised.

What followed was abuse and accusation for not allowing Agnes to barge in and monitor Teresa’s practice. She refused to listen to any explanation Teresa offered. The words used were, “You will do it.”

The manner was just as authoritative as that of Agnes, if not worse, in terms of more power behind the speech.

Teresa felt herself crumbling. Everything became a bit hazy.

Then, without warning—and to her horror—like a flood, she soiled herself. In shock, confusion, and embarrassment, she ended the conversation and said, “I have to go!” Through tears, she realised she had to go home. Still shaken, she wrapped her jacket around her, explained the situation to her office friend, and proceeded towards 44

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the car park. She would inform her manager of the accident in the privacy of her car, before she went home. On her way to the car, a glaring Agnes confronted her, accusing her of going home without permission. In a shaky voice, Teresa explained that she needed to talk to the manager in the privacy of her car, as she was unable to speak in a public place due to her current condition. Her manager, to her credit, that one and only time, was considerate and supported Teresa’s need to go home to clean and get composed Barely able to see the road through her tears, she got home with difficulty. How does a fifty-one-year-old reach this point? She could not believe what had just happened. She made phone calls to her husband and a fellow colleague who was one of her allies at the time. Home was her haven. Her husband comforted her when she arrived home. She hastily went into the shower to get cleaned up.

Her colleague who worked close by dropped in, she would regret not showing her colleague the evidence of that significant event.

She was too embarrassed. Her colleague was aware of what had happened. However, when that colleague turned against Teresa as well, Teresa thought she might have been more supportive had she seen for herself the evidence of that nasty and momentous morning.

She visited her local general practitioner and was treated for emotional, traumatic stress. From that day on, she struggled with irritable bowel syndrome, which, as described in the literature, can occur as a result of stress.

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2.8 Management Plan It was clear to Teresa that the day had not been handled well. Viola informed Teresa that she was required to write a report of the events that had taken place. It was well defined that, by the actions that followed and mistakes made by management the incident would be covered up, no matter what. Firm strategies are set in place by management to go after the victim in order to make him or her look bad. The first attempt is the introduction of a management plan. Not only does this look good to higher authority, it also informs the victim that the focus is on her as she is one at fault, a great step in the direction of lowering one’s selfesteem and feelings of worthlessness. With full support from higher authority, they will stop at nothing to protect themselves, and they will get full support from management to carry this out.

Management’s approach was now to find fault with every little mistake made, the aim to place as much pressure as possible and squeeze Teresa out. Meetings with the manager at the major hospital, was scheduled and would become a regular scenario to eat into Teresa’s already scarce time. A management plan was introduced.

Teresa’s progress would be monitored. During this time, hostility and indifference continued towards her, and Agnes’s attitude was unchanged. Teresa was convinced that values on the database were sometimes tampered with to create ammunition against her. A major flaw in the system was the fact that all parties were able to access the data and make changes. An inexperienced person set up the database. It was difficult to work two days a week and be consumed with meetings, phone calls, and rude emails. Meetings continued to eat into her time as she struggled to manage with the workload. Some days when she got back to work, she was hardly in a state of mind to effectively carry out her job.

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The meetings became very threatening when representatives of higher management were brought in to increase the intimidation, and management at higher levels stepped into the meetings. Some days she was so overwrought that she was not sure where she was.

Human Resources became involved, and even an educator, as a random outsider, was brought in to increase the pressure. Increased Stress levels, exacerbated by sick children, meant that she was not always able to attend the arduous task of an emotional high powered management meeting. When this situation occurred manager Viola would get on the phone, berate Teresa, to the extent, of rendering her ineffective in her other role. The pneumonia her son was struggling with, was adding to the stress, she felt her life was crumbling around her.

The repeated harassment led her to make mistakes. In addition, she continued to attend staff meetings. Quite depressed and hardly sleeping, she was now under the care of a general practitioner and a counselor. To add fuel to fire the educator who intervened, with unfounded reason, decided to perform a full-scale patient assessment on Teresa. This came as a shock and an embarrassment to Teresa, as among her chief strengths were her clinical skills and strong knowledge base. Much to the relief of her allies, Teresa refused to participate in the degrading scrutiny.

Because the main accusation was that she was behind in her administrative work, Teresa was unable to comprehend the reason for a clinical assessment. Clearly, the assessment was a tactic to increase the pressure.

All management plan meetings discussed the same old issue.

Why was the administrative work incomplete? In response to each instance, Teresa explained that time was needed and current circumstances were inhibiting her from doing the work efficiently.

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The meetings were extremely stressful and took a big chunk of the day. In the meantime, patients continued to present with acute and chronic attacks. Workload increased and time became scarce, despite that time was consumed with meetings, wrongful accusations, and let downs to render her ineffective in her role.

In addition to other issues, Teresa was never recognised for any positive contribution she made to the program. Her efforts to organise education days, went unnoticed; despite being commended by most nurses and receiving a good evaluation for her teaching skills, she received no appreciation from her management team.

Travelling the furthest, she always made it to help out on education days, while one colleague forgot the occasion was even scheduled and only arrived after a reminder. As expected, the incident was ignored by the management. One patient was that impressed with the care and teaching he had received that he made a solid financial contribution to the program. The accolade provided in a letter to the team went totally unnoticed. Instead, it was always about slinging insults and accusations to the now fairly fragile Teresa.

Teresa was shocked to find hard copies of rude emails missing following her vacation, she became suspicious when she realized that Agnes had relieved her while she was away. Another chastising moment from Viola for Teresa while at her other job; when unable to attend a meeting. “You will attend the meeting, and I will expect you there at nine a.m�, came the demand.

Teresa was so distressed that she was unable to perform her duties effectively that day. She seriously could not take the added stress of a meeting combined with what she was facing at home, a sick eleven-year-old who had been diagnosed with pneumonia.

Fortunately, Teresa contacted her union representative and mediator, 48

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who reassured her that she did not have to attend. Teresa’s emotional state began to deteriorate. She became depressed and visited her general practitioner more frequently, and as she was unable to function in the workplace, she began to require time off. Her sleep patterns became more disturbed, and her other job was being affected as well. The sleeping tablets that her doctor prescribed gave her a nasty reaction. She would wake up, rummage through the fridge, and do inappropriate things‌ and then remember nothing of the incident in the morning.

At the meetings, she tried to explain that, given time, and reduced pressure from the absence of on-going meetings would solve the problem. Management did not like to hear the truth. The more they got logical answers, it seemed, more determined they were to raise the stakes higher. The constant meetings were a major hindrance.

At times, the treatment was so threatening that, when she returned to the workplace, she was barely able to function. She went on stress leave, and at home with not a lot to do, became more depressed.

Following a series of meetings, Teresa was horrified to receive the directive that she would work at the big hospital with the bully Agnes, carry patient files ninety minutes away from her home hospital, and catch up on data entry and administrative work under the watchful eye of Agnes and Viola. The very people who perpetrated the bullying and intimidation would monitor her closely. She felt like she was in kindergarten. What was senior management doing? Nothing!

She could take it no longer. One day, she wrote a letter to her children and her husband and placed it in her top drawer. She got her husband’s antihypertensive medication and placed them in her pocket. One morning while her husband was at work and her children at school, she took two tablets. Her blood pressure was usually very normal, and she was a bit unsure of what would happen 49

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however her feelings were, that gradually her blood pressure would drop. She knew there was a lot to live for, but she could not see past her current situation, the unfair treatment and the unreasonable expectations. She became irrational, and all logic seemed to fail her.

Even the optimistic side that reassured her that she would overcome the anguish she was facing right now seemed in her far distant past.

After taking the medication, she became afraid and wondered how her children would cope without her. Sitting in a chair on the patio, she fell asleep.

“Are you okay, Mum?” A shake from her daughter, who had just returned from school, awoke her.

“What are you doing asleep out here? You like never, sleep here!

Aw, well, what’s for dinner? Got my English assessment back, and Miss Jones was pleased with my effort!”

Teresa dragged herself out of the chair, all too soon realising the tragedy her daughter could have come home to. Fear and sadness entered her very being. She decided she must work through the situation.

She was relieved when her counsellor advised her that she should not have to go to the big hospital to enter data and perform clerical duties and suggested that Teresa refuse to consent to the demands.

She said that doing so would achieve nothing except an anxious person and maybe work that was partially completed.

Teresa did not confide her near suicide attempt with anybody.

She had sufficient common sense to realise that suicide was not a good option; however, she still carried the tablets around with her in her pocket, just in case.

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POEM WHY DO YOU TREAT ME SO? Why do you speak to me that way, dear?

Why are your eyes so cold?

You moved the goal post and raised the bar.

You never seem to be satisfied, No matter how hard I try.

You take credit for my work and constantly ignore me.

It feels like beneath the surface I lie.

You turn the other way when I speak.

You find fault in all I do. to please, or your approval, to seek.

And the drive, to subjective meetings?

Some days, I wished the brakes on the car would fail.

Your rude phone calls are so unnecessary.

And tact is rather slim.

My colleagues have been well catered to

My contribution is never acknowledged.

Opinions hardly ever asked.

To keep me out of the loop is common, 51

Even in circumstances that are quite important.

Your abusive emails and abrupt words flow freely And yes they are quite distressing.

So is your pat on the back to someone else when Really it should have been me!

Sadly, your lies, deceit, and prejudice Have been propped up by higher authority!

Does it give you a cheap thrill?

Somehow, I feel sorry for you, my dear.

The hurt and pain you have caused will return to you like a strong bitter pill!!

Ingrid Pryde

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CHAPTER THREE

Running the Gauntlet

A nineteen-year-old girl commits suicide. A twenty-two-year-old is huddled in a corner at 6:00 a.m. and says to her mum, “I don’t want to go to work today!” In the same context, a fifty-one-year-old mother of five suffers repeated bouts of vomiting before heading off to work. Bizzare? Yes, but also true. The very real casualties in our society today, those described here and many more face the shameful crime of bullying, harassment, and intimidation in the workplace on a regular basis.

Unfortunately, the nursing profession serves as one of the main settings of this crime, and nursing professionals are among its chief perpetrators. Safely hidden behind a mask of a “caring profession,” the act is well covered, and its existence denied by many a manager and leader to protect an aberrant culture that is fermenting rapidly. The consequence is a behaviour that is disregarded and denied because, quite often, leaders and managers are the ones committing the crime.

Taking the victim’s side is, at best, extremely rare and, at worst, absent. It is highly unlikely that a nurse would take another nurse under her wing and lead the way to constructive nursing procedures, competent patient care, and the general philosophy of nursing, the 53

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way in which she learnt. Objectivity is unusual. Bias is the common attitude and often leads to bullying, especially when bias is against one who is vulnerable and fragile or one who demonstrates ability and more experience in the workplace.

As one clinical nurse consultant repeatedly would say to Teresa, “Your clinical skills are second to none.�

However, she would continue to practice coercive bullying: keep Teresa out of the loop, talk down to her, and devalued any clinical contribution she tried to make in the workplace. It was a contradiction in terms. On one hand, she complimented Teresa for her clinical skills while, on the other, she perpetrated bullying practices, both the overt and covert kind.

An overqualified nurse with solid experience becomes a sitting target waiting to be victimised and to be put in his or her place. Do not think for yourself, please! Constant nit picking, ridicule, and personal attacks can leave the victim helpless and in disarray. It is a mindless strategy that bullies use. It can cause as much confusion within the mind of the victim, and soon they will start to behave strangely due to anxiety and stress. Of course, it makes the bully look good and in control. Complain to seniors, and more trouble follows. It becomes a lost situation. The only alternative is to leave and move on. *** Teresa fell victim to the growing culture of bullying in nursing, which was spreading like a cancer. She was about to face one of the most challenging days ever in the workplace. She was scheduled to attend a meeting one afternoon to discuss her performance. She knew full well that a plan was afoot, a strategy that the bullies devised 54

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to degrade her, a design to destroy her confidence and to totally humiliate her as a person. Confidentiality did not exist. She heard through the grapevine that something bad was brewing.

She had attended many meetings in the past six months. However, this particular one stood out. Four people were present at the meeting, and she had a bad feeling that all were out to humiliate and give her a hard time. The night before the meeting, she tossed and turned in bed.

Why have I hung in so long? I should have moved on a long time ago and looked for another job. It’s too late now.

But Teresa was not a defeatist, and she knew she must see this issue through to the end. She was not ready to quit yet. She needed to figure out what the new plan was. Would she be able to cope and come to some compromise? She hoped there would be a softening of her trial, but she had a strange feeling that all would not go well.

When the morning of the meeting arrived, she reluctantly slipped into the driver seat of the family car, turned the ignition of the automatic transmission, moved the stick from neutral into drive (or so she thought), and pressed down on the accelerator. And to her dismay, instead of moving forward, the car moved backward into the garage with a bang. A shudder of anxiety ran through her as she realised that this was a bad start to the day. Cradling her head with her hands and resting it on the steering wheel, she wondered if the mishap was an omen.

Drawn outside by the noise, Martin rushed to her aid. He found his wife slouched on the steering wheel and extremely distressed. “Honey, please, let me drive you to work,� he said with worry and compassion in his voice.

Teresa knew she would be greatly relieved if he drove her to work, but she also realised that the day would not be a usual day at work in terms of driving to the beach side hospital, the day would 55

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included a second journey to the big hospital an hour and half away from the first location. While Martin’s motive was honorable, it was impractical on this occasion. She thanked her husband for the kind gesture and reluctantly explained she must drive on her own, reassuring him she would drive with care.

She pulled herself together. She knew that, in the current circumstances, he was thinking of her, and that was more than enough to keep her going. The simple knowledge that he was thinking of her was of great comfort. She blew him a kiss and headed off to work. That day would set the pace for the next few months and became a watershed in Teresa’s fight for justice. She was under no illusion that the meeting would go smoothly.

She drove along to her small beachside hospital and reflected on the last half hour. The sun was bright, and its comforting rays gently warmed her cheeks as she drove down the main road. The air smelt clean and fresh, conveying crispness, unique to the season of birds nesting and flowers in bloom. The purity of spring seemed to contradict the darkness that loomed ahead. Unable to draw away from her concerned mind and anxious thoughts, Teresa drove to the car park and looked at the ocean in the far distance, wishing she could go whale watching instead of facing the dreaded meeting.

It was a usual day at the hospital. There were new admissions overnight, patients who needed to be screened and followed. Some patients needed to be assessed to verify whether they fit the very strict, stringent criteria required to enrol in the chronic disease program. Teresa had been warned not to educate the “very sick,” like one elderly patient who was tagged NFR, the irony of a caring profession. If she were to follow the program religiously, she would let the dying go home to drown in their fluids. Educating them to selfmanage their illness underpinned their quality of life and longevity.

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It also empowered them to take control of their bodies and learn self-management in terms of fluid balance, daily weigh-ins, and the monitoring of their salt intake to detect early signs of fluid overload and observe for physiological signs that could predict a pending medical crisis. In other words, she would use plain old common sense. She was discouraged from educating the dying (NFR) and even got into an argument with the three bullies—one the interfering educator who had decided to perform the dodgy assessment on her— at one meeting. Who would deny the education of a dying person to go home and be made comfortable? One would have to have a lack of compassion and empathy to embrace this attitude, one that would make Florence Nightingale roll in her grave. (God bless her.)

The bullies did not look good at the end of that argument. While the protocol did not change, Teresa won the argument at the staff meeting. Three weeks later, when Educator Jane and Team Leader Agnes walked into Teresa’s office, they had one intention and one intention only. They wanted to set their victim straight.

Ideally and based on the requirements of the program, it was imperative that, as patients became educated, their quality of life would improve, and the number of readmissions would be reduced.

As a result, the pressure of the hospital system and its costs would reduce, while patients would learn to manage their chronic disease.

It was a great idea; however, the true principle of the program was not followed because variants were introduced, and other elements, like administrative work, increased.

In real terms, Teresa made strong efforts to get around to as many of the elderly as she could, and she was seeing as many patients as her counterparts, who were working more hours than she was.

When she initially took on the job, she travelled around to nearby hostels and nursing homes to educate staff about management of the 57

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chronic disease. She was amazed to discover that so many health workers had limited knowledge and were not aware of self-care in the chronic disease management. Some were terrified of their patients having an acute attack in the middle of the night, as they did not have the resources, expertise, or confidence to handle the situation and hence embraced the information that Teresa was giving them. Some staff members came in on their day off, and others sought Teresa after her talk to seek more information while they sipped on coffee. They were keen to learn about preventative health measures and expressed interest in prevention rather than acute intervention.

One particular nurse was horrified to have witnessed an acute attack that one of her patients experienced. The process did not go well for her, and at one stage, she thought she would lose her patient, limited resources in most nursing homes make it difficult to treat a patient with an acute illness. After some nail-biting moments, the ambulance was there to take her patient to the hospital. The key is prevention.

Of course, not everyone was enthusiastic about learning, but the overall majority appreciated the teaching session. Teresa considered the fact that she had limited time (two days per week), and firmly believed that if she got other local health workers on board, they could collaboratively assist to keep the local hostel and nursing homes as well as the community in general healthy. The phrase “knowledge is power� goes a long way, especially when it comes to knowing and understanding what you are dealing with.

As a result, Teresa found that a good majority of her patients were not readmitting within a six-month period. This was not only great as a statistic, but it also served as evidence that the local elderly community was healthy. However, management chose to ignore the reduced readmission rate. Because bureaucratic procedures were not 58

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followed and administrative work was falling behind, they decided to continue on the road of harassment to increase the stress. Teresa was achieving exactly what the program had set out to do. Working two days a week, she was carrying out the job and addressing the main issue of readmissions. But something had to give. The medical consultant who was in charge and who had set up the program was like a puppet in the hands of the bullies and basically did what they (bullies) wanted. When Teresa wrote the minutes for their monthly staff meeting, she was told, by Agnes that the minutes were written incorrectly, though her style of writing minutes had garnered praise from one of her previous managers in intensive care. She followed protocols, such as members present, motions, resolutions, identification of speakers, and the content of their speech. The written minutes, reflected that Agnes dominated the staff meeting, the revelation was confronting. It was fact, and the document would need to be filed. The minutes as suspected was removed from the file therefore to all intents and purposes that meeting did not take place.

The perfect cover up.

Making changes or being flexible was out of the question as far as senior management was concerned. They were incapable of looking at the big picture and were satisfied to hear only one version of the story.

When the situation became worse, they stuck with the only version they knew. Bias set in, and there was no going back. They were happy with double documenting, wasting time travelling to meetings and going back three years to enter data for some three hundred patients.

Going back and entering data made sense for purposes of keeping statistics; however, when there is limited work power and patients continue presenting to hospital, it is not rocket science to see where the resources need to be directed. Many of the problems stemmed from entering backdated, current, and accumulating data.

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Because time was of the essence, data entry became a secondary issue to the real problem of constant admissions, education of patients, and subsequent follow-up. However, management was unable to understand this necessary fact in the context of the program’s goal to treat the sick and became irate when data entry was behind. Of course, as Teresa worked the least number of days, she was furthest behind.

Forward thinking and troubleshooting were out of the question.

While staff from other areas was participating in video links, the staff from the chronic disease program wasted long periods travelling to one central place. Teresa travelled the farthest, an hour to an hour and a half.

The morning seemed to drag. Teresa found herself reflecting on all her efforts to be productive and to perform what she thought was the right and best practice. On the day of the meeting, she was unable to concentrate. Her mind kept flicking back to the earlier mishap with the car, and she began to wonder what was in store for her later. She must leave her workplace by noon to arrive at the meeting, which was scheduled for 1:30 p.m. She headed off to the meeting that afternoon, and she was aware that the next couple hours would be difficult.

“Character building” was how one ardent nurse educator described what lay ahead for Teresa. She optimistically clung to that last phrase in the hope that she would look back one day and see the experience as one that had helped to nurture, shape her character and give her an inner strength. The drive usually took about an hour and a half. During the last two and a half years, Teresa had travelled this road several times to her monthly staff meetings. The day of the meeting, however, was different. She was uneasy, and her stomach was in one big knot. Even the tranquil Wakehurst Parkway, which 60

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usually had a calming effect on her emotions, failed to do so that afternoon.

Finally, she arrived at her destination. Renata, her support and union representative, arrived late and was not as friendly this time.

Had her allegiance swayed? Had somebody spoken to her to cause a bias? This was an added worry for Teresa. She needed union support to pull through this situation. She needed somebody on her side. She smiled warmly at Renata, her now “maybe” support person, who sat beside her.

This scenario quite often occurs when bullies, especially those in positions of authority and influence, whisper into potential allies’ ears. Objectivity flies out the front door, and the situation becomes corrupt.

Renata, seeming rather uncomfortable, shifted frequently in her seat and avoided eye contact during discussion of some of the issues that had prompted the meeting. The long pauses and Renata’s tone of voice painted a picture of the unexpected dilemma that Teresa was facing at that moment. There was not a lot that could be done, and the meeting had to go on.

“Come and sit nice and close to me,” came the chilling comment from Renata, which jerked Teresa back to reality, forcing her to straighten up as she tentatively walked into the boardroom.

Despite the flood of mixed emotions she was experiencing, Teresa knew it was imperative for her to be on her guard. She was convinced the meeting would not go in her favour; however, at this point in the argument, she needed to stand tall and be counted, not just for herself, but for all the other individuals who were and who continue to be bullied and intimidated by senior nurses.

She was ushered to the other side of the table, opposite the door.

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austere, cold and very formal. This was not going to be a social chitchat. The long, rectangular table, which sat about twelve people, looked ready to make an important corporate deal, not discuss the fact that data entry was incomplete. This scene represented one of nursing’s enigmas, “Use a sledgehammer to crack a nut.”

Two managers and the educator entered the room and strategically took their seats. The rectangular table filled the boardroom. Educator Jane sat on the opposite end diagonal to Teresa. A manager from an unrelated area sat almost directly opposite Teresa, and Viola sat at the head of the table to Teresa’s right, close to Renata, a few seats away. Teresa chose the middle seat at the lengthy table with her union representative by her side. The educator and other manager seemed to sit in strategic positions on either side of the door, which gave the appearance they were guarding it.

Locked in! Teresa thought as she wondered what position they would have chosen had she sat on that side of the table.

Then she recalled that Renata had ushered her to the seat. They sat very quietly and nodded in Teresa’s direction, a very formal nod, one that gave Teresa the uneasy feeling of being in a courtroom.

Accusations were hurled across the table at Teresa. She tried to defend herself, but to no avail. She was convinced this meeting was a setup. The confined entrance to the large Victorian-style boardroom, blocked by two robust, intimidating senior nurses, seemed to lock her in and subject her into submission. Despite the fact that Renata was beside her, Teresa began to feel uncomfortable and helpless.

The body language demonstrated by the senior nurses did not go unnoticed by Teresa and confirmed the belief that Teresa felt of being on her own. She was against four people, not three. The fairly large educator, seated diagonally opposite to Teresa’s left, and guarding the 62

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door, convinced Teresa she was subject to an unexplained control, judging by the strategic placement of the meeting’s participants.

The interaction between the four people confirmed that Teresa was there to bat on her own. Ironically, one of the four, Renata, was supposed to be her support person. The meeting started to go terribly wrong. Accusations were hurled across the boardroom.

Teresa challenged each one of them, giving her accusers pertinent answers and raising questions with them, especially the manager of the program Viola, who had earlier rung Teresa while at her other job to chastise her for not attending a meeting.

After carefully studying the four people on the panel, including the support person, Teresa decided this was a case of fight or flight, sink or swim. She made the conscious decision to fight. She argued her case, challenging the prime person (Viola) responsible for the intimidation and unfair treatment. She pointed out several issues that exacerbated the abuse and intimidation. At times, she was lost for words. It was announced by the three, and supported by the union representative, that Teresa would work with Agnes to complete data entry at the big hospital to which she had just driven for an hour and a half.

Teresa was horrified. This meeting had been set up to humiliate her to the maximum. The prospect of working with this person would be a constant reminder of the conflict that existed between the two. Teresa strongly believed that she could not be productive, stay focused, and perform effectively with Agnes lurking in the background. Agnes had never treated Teresa well, always snapped at her and constantly found fault with what she did. The embarrassing moment that occurred on June 13 was still fresh in her mind. There was far too much history with this woman, the thought of sitting in the same room for any length of time was unbearable, let alone have her check Teresa’s work. It would have been ideal if an independent 63

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person form the program helped and supervised. It was not as though her manner or behaviour towards Teresa had changed. She remained hostile and indifferent. Viola encouraged the behaviour or sat back and did nothing. Agnes even made a racist comment about Teresa’s Indian background in the context of backyard abortions in India, and the tone she used made Teresa flinch with embarrassment and hurt.

When Teresa was in her twenties, this person was her nurse unit manager. She gave Teresa a hard time even then. She was always curt and never gave her the time of day. At that time, Teresa had been naïve, very timid, fragile, and a new R/N. Agnes’s behaviour then had driven Teresa to a different area in nursing, not because she disliked the work, but because she felt she had no choice.

Now some thirty years later, as fate would have it, they crossed paths again. Teresa, now in her fifties, was confident because she had gained knowledge and skills. Agnes soon began to find fault and started to harass her.

Teresa would be the first to admit errors were made in terms of her organisation and putting some elements of the program together.

However, the manner in which the subject was handled drove her into even more chaos. Like most people faced with this situation, she found it hard to concentrate, and the tone frequently used to speak to her set the pace for errors in administrative work and productivity.

Her strong experience in the clinical setting had taught her to do her best for the patient, and she knew she was conscientious in her efforts towards achieving that best practice.

No, Teresa could not let this person have control over her emotions and her job. Even if she did, there was no guarantee that Agnes would be pleasant and treat her with respect. Realistically, she could not take any more. She must fight this decision.

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Agnes had never acknowledged any positive contribution Teresa made to the program, such as the time she helped to organise education days. (One of her colleagues forgot it was scheduled and walked in late after a reminder, but her initial absence and late arrival were dismissed.) It seemed that she could do nothing right as far as Agnes was concerned. An immediate arbitration would not work, as she needed time to rest and recover from her recent stressful experiences. The incident in the office on June 13, the rude phone calls, and emails could not be resolved overnight.

Teresa tried to convince the regimented panel that their proposal would not work and that she would be extremely anxious and stressed out if forced to work with Agnes, knowing that Viola the manager would be lurking in the back ground as well. She firmly believed they were trying to teach her a lesson by humiliating her into working closely with the person who had the ability to exert authority over her. Any attempts she made to offer alternative suggestions were seemingly dismissed, furthermore an action plan, which Teresa stayed up well into the early hours of Sunday morning to put together, was totally ignored. It appeared that there would be no compromising with these people. It was obvious the intention was to place as much pressure as possible on the already stressedout Teresa.

Roy (2007) aptly points out that bullies have poor consultation skills, are inconsistent in their clinical practices, and have unreasonable performance expectations. The author emphasises that these issues need to be addressed. If not, the bully will find himself or herself in a stable position, aberrant behaviour will develop and become grounded in his or her practice.

In Teresa’s case, a compromise with the panel was obviously out of the question. They were revelling in their power and enjoying the 65

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fact that Teresa would ultimately be forced to do as they said. Their behaviours were cultivated and nurtured in a system that supported and upheld the practice of bullying.

The intended proposed plan meant that confidential patient files would travel an hour and a half from where they resided to the hospital where the bullies worked. At the end of the day, they would then be carted back to their home-based hospital. This procedure wasted three hours of time in travel each day, risk to a potential breach of confidentiality in case of a mishap, car accident, or file loss, inclusive of names, addresses, and phone numbers. Best practice suggests that personal files with medical information, addresses, phone numbers, and confidential issues should be under lock and key. When used or removed from filing cabinet, only authorised persons should be able to access the information. After use, the files should go straight back into the cabinet.

In Teresa’s case, all senior nurses agreed against best practice and approved to allow confidential files to travel ninety minutes away from their home hospital. They gave the directive that files should leave their home hospital, travel in the back of a car to the major hospital an hour and a half away, and brought back either the same or the next day, which meant sitting overnight in the booth of a car or the home of Teresa, well and truly against the law of confidentiality and best practice.

Teresa desperately tried to present arguments in support of her convictions, but the women at the table were not interested.

After a solid hour and a half of debating and feeling very drained, despondent, and let down, she headed home. It was following this meeting that she drove through a red light. she drove steadily home the rest of the way. Later that evening, she began to relate the events of the day to her husband.

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The next day, Teresa dragged herself to a meeting with a pair of retired health workers, a team set up by the area health service, in an attempt to investigate allegations of bullying, harassment, and other questionable practices within the health service. Interviews were held with all staff that had grievances and incidents to report. A report was to follow. The aim was to address the issue within the major hospital in the area, the hospital where Teresa attended all her staff meetings.

However, complaints flooded the retired pair from all five hospitals within the area instead of just the major hospital, leaving them with far more work than first anticipated. The professionals expressed concern to Teresa and explained they had to extend and expand their investigation. Teresa was given a fair hearing, and the team reiterated that the result of all the interviews would be combined in their report.

She refused to work in the main hospital with the perpetrators of the bullying. That was final as far as she was concerned. She secretly suspected that she was being squeezed out of her position.

Following advice from one of her allies, she approached a barrister with a request to send a letter explaining the situation on her behalf. The intervention by the barrister took the situation to another level. Some, like the educator, disengaged themselves from the scene and were no longer involved. Others lay low, and role definitions changed, particularly in Human resource. Teresa began to become very emotionally drained as well. Of one thing she was sure. She would not work with the bullies. She would not give them the opportunity to make her life even more miserable than they already had.

One morning two weeks after the meeting, Teresa received a phone call from Renata, who, with a voice as sweet as pie, suggested that Teresa ring another person on the central coast who was very supportive of Teresa’s cause. Teresa was glad when the phone conversation ended.

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She dug her heels in and refused to take on the role, and work with the bullies, knowing full well there was a less stressful alternative. As a result, Teresa received a letter from Human Resources that stated, if she did not take on the role, she could not continue to run the chronic disease program. The kind director of nursing at the small hospital was sympathetic to her cause, knew of an upcoming role and offered it to her in the hope that it would help the situation until the matter was resolved. The position involved a review of errors related to the dispensing of medication and included, research on evidence based practice based on medication safety, in order to minimize the several mistakes occurring within the two beachside hospitals. In addition visits were made to audit drug books to highlight error and type of errors. Some team members were random, professionals who had an interest in the area, others had professional expertise; such as the doctor, who led the team of about ten. Close by his side was the pharmacist and the nurse; Teresa. The role endeavoured to use this research, via a medical practitioner, to promote medication safety.

The role was challenging, and Teresa took on the role with keen interest. She began to find a new sense of self-worth. While she was paid out of funds from the chronic disease program, she was performing in a different position, a pleasant role. However, she knew it was not permanent. Lurking in the background, was the call to work directly under the bullies. She knew they relished the thought of humiliating her while she worked under their watchful eye. She was also well aware that a higher authority supported those against her and she was fighting a losing battle.

She took an interest in medication safety and the role recommended by the director of nursing. Gradually, her self-esteem increased again, and she performed her duties well, so well in fact that the doctor who was running the program complimented her.

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She was enlightened and concerned about the many errors made in medication dispensing, the lack of accountability related to the use of dangerous drugs, and the unexplainable loss of addictive drugs.

Her research revealed that the problem was a global issue and that hospitals around the world were working towards putting strategies in place to reduce the errors. Some of the errors were causing unnecessary deaths, a situation that required urgent attention.

Sadly, she met another health professional who was being bullied in the workplace, and once again, she was faced with the dirty secret of nursing, a contradiction in terms, “the presence of bullying” and “a profession of caring.” She waited patiently for some resolution of her previous role but nevertheless flourished in her current one.

Despite writing letters to senior managers and pleading for a resolution in her favour, she was abruptly told she must comply and go to the larger hospital. It was evident that a compromise would not occur. Three months into the medication safety role, she was sent another letter from both her manager and Human Resources. The letter stated that her salary would cease in a fortnight’s time should she not take up the role of entering data at the large hospital. She had just begun to pick herself up from rock bottom, and she was fed up with the negative and unprofessional behaviour of all involved. After being removed from the stressful situation, she dreaded the thought of being forced back into it.

Quite often, when one is in a particular situation, it is difficult to see the truth behind the behaviours or events, and the abnormal becomes normal. That is how Teresa was feeling. She kept going, and the bullying continued. Her emotions were on a roller coaster.

It was not until she changed roles that she realised the difference in her wellbeing and understood the extent at which the bullying and harassment had affected her. This realisation persuaded her that 69

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she must move on despite the very demanding letter from a senior manager telling her to fall into line and get herself to the big hospital.

Two weeks later, a desolate Teresa resigned from her duties as coordinator of the chronic disease program. She felt relieved. That same week, Teresa went to her other job. She explained the situation to her manager, only to be accused of not being focused. She walked away feeling very despondent.

What is it with nursing? Why are human beings so cruel? And what about nurses? What makes them so cruel?

She would continue to ask herself those questions over the next couple of years.

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CHAPTER FOUR

The “Untouchables”

Introduction Today, bullying permeates our work areas—and even our homes— via the Internet in the form of cyber bullying. Employees should not be afraid to go to their places of work, and no one should experience trepidation in what should be the most secure of places, their homes.

Although some believe the crime is carried out only on a school playground or in the classroom, the issue of bullying touches just about every discipline and all walks of life. Childhood bullying thrives in almost every school. As a result, teachers and principals are actively involved in trying to stamp out this criminal behaviour, which can emotionally cripple a growing child.

4.1 Victimisation Victimisation takes on all forms, from berating, nitpicking, undermining to overt and covert behaviours. Micromanagement can be a form of victimization.

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Articles in newspapers, magazines, and verbal reports outline definitive incidents of bullying. Despite this, leaders continue to deny the fact that it exists, and close to nothing is done to rectify the situation.

The nursing profession is swamped with reports of corruption and complaints of nurses being bullied in almost every area of nursing and all over the world. Many of these complaints are not made public. Because the profession has been a closed shop, it is seen as disloyal to come out and tell all. Times are changing, however, and more nurses are speaking out about the crime of bullying. With the help of an open, supportive media, proactive governments, ardent educators, and researchers, the twenty-first century can be a new beginning in the workplace. Hopefully, as a result of interventions, the bullying trend can be reversed.

Search the internet, and several incidents of abuse and cover-ups will be revealed, related to “the dirty secret of nursing” (Span 2012).

Media attention has brought the offence to the forefront. Regrettably, senior leaders continue to deny its existence largely because the bullies are quite often leaders and managers themselves. Nurses on the floor or those like Teresa who have a direct-line manager can verify its existence. Particularly those working on the floor, who often fall prey and become victims of the offence.

The victimisation can be quite effectively carried out by unfair rostering practices, failure to approve leave, inappropriate patient allocation, a target of favourites to be in charge on shifts, and general nitpicking; common practices in the bully’s repertoire. The reality is that the senior bully can exert her or his power to make a subordinate’s life extremely difficult and miserable.

The research on bullying is quite interesting. Several authors have tried to unfold and reveal what lies within the perpetrator 72

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who is callous enough to inflict this often subtle—and sometimes confrontational—cruelty towards vulnerable human beings. There is little consolation to the fragile victim who consistently experiences the wrath of a person, abusive, dramatic, and not hesitant to dress her or him down in front of anybody. In some instances, the bigger the audience, the better the show.

Randle and Stevenson (2007) aptly identify bullying as inappropriate, unproductive, and totally unacceptable. The suggestion is that these habits are grounded in the bully’s own insecurity, exacerbated by a relative lack of ethical and social skills.

If you read that, you have comfort in knowing you are dealing with a form of mental illness. Delms (2009) makes a strong claim that the worst bullies are psychopaths who are found at the top levels of organisations and are often rewarded for doing their job, regardless of how they conduct themselves.

Teresa found this to be the case with Agnes. While Agnes performed well in her role, her domineering behaviour was overlooked, even when it reached the point that it was creating conflict within the team. Her manner even intimidated her superiors.

Another bully with whom Teresa worked would be extremely pleasant to those above her and fostered great relationships with them; however, when it came to relationships with nurses under her, she had little time for them and was always quick to put them down through gossip or belittling.

The latter may be one of the psychopaths that Delms discusses.

The author speculates that the leniency with which they are treated probably comes from the fact that they are seen as experts in their field. That is true to a great extent; unfortunately, this expertise seems to give them the rationale to justify their behaviour towards others.

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An overall review of the literature reveals that managers are often perpetrators of bullying practices, highlighted is the fact that their management practice styles and skills can be poor and even inappropriate. It is believed that, overall, bullies are role ambiguous and have an overinflated view of their position and importance. For example, one manager persistently claimed that she was the one personally paying Teresa’s salary. In actuality, all wages came from a central area health system. Teresa was no more paid by the manager than Teresa paid the manager. However, making that claim seemed to give her a sense of power and made her look good in front of her patient clients. This same manager took a box of chocolates that had been given to the nursing team by a patient, gave it to the ward clerk, and quite brazenly said it was from her (the manager). She then went a step further and informed Teresa of her deception. In other words, she dared Teresa to keep her deceptive behaviour confidential.

4.2 Professional direction of new nurses It is quite disturbing that some authors draw attention to the fact that new nurses, by role definition, discover that they must throw their weight around to survive and succeed. It is worrying to comprehend that a breed of recruits may turn into bullies as the result of experiences with negative practice management. Many nurses, however, are deciding or will decide that nursing is not for them. They will leave the profession or use the experience as a stepping-stone to another career.

During a particular period, when Teresa did some clinical education for undergraduate university students, she was taken aback to discover that a significant number of students came through 74

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with the distinct intention of changing their professional direction.

Their reasons included the fact that nursing was not what they expected it to be and/or they did not like the atmosphere in the workplace. Some had bad experiences in their clinical placements, which prompted their decision to leave the profession. Others were a group who intended to change courses at the outset of their careers.

The profession is unable to afford this loss. It is imperative that the nursing shortage be addressed. The system must be proactive to not only attract recruits, but it must also make it worth their while to stay.

4.3 Scenario Teresa observed with some sadness one dear mum who expressed concern for her daughter, who was struggling in the hospital system.

The daughter, who worked in a major city hospital, found that her patient allocation was consistently inequitable. She also discovered that friends would help each other and leave the loner with the heavy workload. The young nurse soldiered on in the absence of help and support. It is essential that the team leader be aware of circumstances such as described.

Teresa got into many an altercation over unfair patient allocation, one instance goes that some nurses sat around talking while one or two others literally ran most of the shift. It is therefore the responsibility of the team leader to reallocate or deploy, even if it is temporary, and to monitor staff to ensure an equal and fair distribution of workload.

Team leaders need to have training and development before they are allowed to take the charge role. One hospital in remote central 75

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Australia selected nurses who had leadership potential and sent them to training. What was missing was an anonymous evaluation of the team leader’s work practice. Such an evaluation would not only make team leaders accountable, but it would also curb or highlight any coercive bullying tendencies they may have.

4.4 Anxiety Internet bullies are on the rise, and email is a common medium used for this practice of bullying. In fact, Teresa would feel tense whenever her inbox indicated that an email had arrived from one of her undesirable managers. She would put off reading these emails until the last minute when, unfortunately, her anxiety would have reached its maximum level. Each time the phone rang, she would be extremely distraught, her heart would skip a beat, and she would be reluctant to answer. Some days, she would let calls go to voice mail.

This made matters worse because she was then accused of not being at work or of having gone home early.

There is no mistake that bullies thrive in organisations, particularly in a culture that encourages belittling of employees.

Sometimes, they are heard to be bragging about their encounters.

They love an audience and the sound of their own voices and revel in gossip. Their support structure unwittingly allows them to continue controlling, undermining practice through the organisational culture and the subtle backing of higher authority they inflict anxiety and high levels of stress on their victims.

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4.5 Research Compelling evidence in the research suggests that nurse managers are strongly implicated in workplace bullying. In fact, there may be a direct link between episodes of verbal violence and aggression towards nurses taking sick leave. If patient allocation is skewed and not rotated fairly, the nurse has to deal with difficult rosters constantly, and fault is found with every move she or he makes it can be guaranteed that nurses are going to react. When this happens, the workplace is clearly not a pleasant place in which to be, sick leave increases, recruitment and retention is affected and in a worse case scenario the employee would have to contend with burnout.

Randle and Stevenson (2011) and Cleary (2010) point out that repeated exposure to bullying may lead to a feeling of helplessness and disempowerment. As a result, depression can set in and, at times, lead to life-threatening situations. Teresa reached high levels of depression, and she was frequently on sick or stress leave, when the bullying was at it’s worst.

Jackson, Clare, and Mannix (2002) and Randle (2003) highlight the anxieties and distress caused by such experiences, coupled with the inevitable damage to self-confidence, that exacerbates the difficulty the victim faces in terms of taking the initial steps towards a more constructive response to the situation. Irrational behaviour results, along with a continuing inability to face the bullies. Teresa succumbed to this pattern when she faced the dilemma of working at the big hospital under the watchful eye of the bullies while she entered data. Finally, it became too much.

In her personal life, she was unable to think straight. Professionally, she began to make mistakes and became more unproductive. She soon discovered that refocusing after a negative verbal encounter was 77

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developing into a difficult task. Even an email would set her back in her productivity. Situations she was able to handle and rationalise previously became inordinately difficult for her.

Bullying has major effects on self-esteem, and practices within nursing perpetuate it’s manifestation. The situation must be rectified.

Educators must transform their practice and, in the process, shed some light on this very real problem, which is currently being swept under the carpet. They need to discuss its existence and commit to working towards a resolution by providing tools for recruits and staff alike to manage bullies in the workplace. Bullies must be aware that they will be held accountable for their actions. There should be a strict code of conduct that all are expected to abide by. Regular in-services should be held, and attendance must be mandatory.

In addition, management must embrace a zero-tolerance practice towards bullying, as is practiced in one US hospital.

Just as signs are posted in bathrooms and corridors with advice on infection control, warnings to deter bullying behaviour and instructions informing victims how to report bullies should be plastered on billboards. It is imperative that these cowardly acts are dealt with. If not, each new generation of nurses will continue to be exposed to this negative practice. As a result, their feelings of self-worth will be undermined, and standards of nursing care will be jeopardised.

4.6 Power and its downfall It is an accepted fact that power corrupts. Those in positions of power have the potential to create monsters if their influence is misused.

Certain situations, such as responsibility for rostering and approving 78

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annual leave or patient allocation, foster violation of power and can manifest in the form of bullying and intimidation, overtly or covertly.

The literature suggests that inadequate managerial training or absence of a strong, stated value base can actively nurture the bullying trait. An existent destructive culture of blame, distrust, and insecurity is embedded in the mentality of the bully. Furthermore the lack of interpersonal, organisational and communication skills, as well as the autocratic nature that adds to characterize this type of person, it can bring chaos and disharmony into the workplace.

Bullies are hard to please, and they will deny their victim any credit or praise for hard work. They take pleasure in seeing their victim fail or struggle. It is worth repeating here that the key to resolution is adequate training and a zero-tolerance policy. With that in place the bully can be brought to justice.

4.7 Theories At this stage in the book, It is worth bringing to the forefront relevant theories that highlight behavior patterns. Theories, as a rule, set up a platform by which practice can be measured they can prove to be of value in any area of clinical practice, will enhance guidance and gives direction.

Modelled on Maslow’s theories on need for self-actualisation; McGregor (1960) formulated theories, X and Y, categorising behaviour patterns of the individual. Theory X highlights the notion that bullies are inherently lazy and self-centred and they are prepared to work only when unavoidable, are power hungry, do not accept responsibility, and are resistant to change. Most bullies have one or all of these traits.

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On the flip side, theory Y describes the ideal leader as one who is naturally inclined to work and enjoys it, has self-control, seeks reward in terms of self-esteem and a sense of achievement, and is proactive towards creating a harmonious working environment. It is not difficult to predict which theories reflect a positive outcome.

Maslow (1943) developed the hierarchy needs model, which is still relevant today and is used to understand human motivation, management training, and personal development. Maslow’s theories pivot around the employer endeavouring to provide a workplace environment that encourages and enables employees to fulfil their individual unique potential; self-actualisation.

4.8 Harsh words and hurtful behaviour “Sticks and stones can brake your bones, but names can never hurt you”, untrue statement, ever! The impact harsh words and rude behavior has on the individual is far worse than the healing of a broken bone. However the phrase is still used in the playground and gives some comfort to victims; or does it? All the research leans towards the fact that it takes years to recover from emotional damage and some never do.

Management behavior can often be responsible for verbal and emotional abuse in the workplace. In an attempt to discuss managers, Randle (2003) critiques styles of management and points out that an aggressive, self-centred manager will say, “I am okay; you are not.”

How true! The assertive manager will say, “I am okay; you are okay.”

The submissive leader will say, “You are okay; I am not.” It is obvious that assertiveness is the best approach. Beyond that, you have the collaborate manager versus the autocratic one—the collaborate one 80

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who promotes mutual respect as opposed to the one who demands respect but refuses to reciprocate it. The autocratic one can also be the inconsistent one, which is frustrating as one does not know what to expect, and the workplace hinges on her mood, creating an atmosphere of disharmony and tension.

Teresa was subjected to the autocratic leadership style when she worked in an area of primary and secondary health care. Some days were almost too difficult to bear. The expression on her manager’s face, especially on her first day back from vacation (typically the worst day), indicated the day would be challenging. She would continuously find fault, and trivial incidents would be exaggerated.

It would have been nice to hear her say, “Thank you, guys, for holding the fort in my absence.” Instead, she was grumpy all day and would go out of her way to nitpick, convincing herself and everybody else that the place did not function adequately while she was away. In actual fact, it functioned even better because the pressure was off, the atmosphere was relaxed, and the feeling of walking on eggshells was absent. In this day and age, it is extremely rare to find a manager who will go the extra mile to praise a person for a job well done. The lack of thankfulness exposed by this behaviour emphasises that leaders orchestrate bullying in the workplace.

Coercive power is extremely damaging, and some bullies quite skilfully execute this pattern of behaviour. Unfortunately nursing lends itself to the aberrant conduct in addition supported by organisational culture this form of bullying soon finds fertile ground within the profession. This growing trend—to suppress the victim—is a form of power used by bullies to force their victims to participate in or take heed to their demands. The psychological stress as a result of coercive bullying can place enormous pressure on the victim. In work situations, coercive power is used to withhold information, reward 81

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the undeserving (as the bully sees them), withdraw or refuse support, devalue a person’s expertise or integrity, and socially isolate the victim.

Other behaviours can include explosive outbursts and threats, ridicule, constant unnecessary monitoring on the person’s work, a question of professional ability, and the spread of damaging rumours.

These behaviours are extremely stressful for the person at the receiving end. The result is a fierce feeling of injustice and a violation of human rights. Victims will eventually expose the abuser or move on, triggers like fight-or-flight scenario will come into action; it must be emphasised that long term action of the response can result in damage mode. Fighting means bringing the case to the forefront, this takes courage and determination and can cause a lot of stress and anxiety. Many victims believe that exposure will stop the bully; however, the research clearly suggests that bullies are reoffenders (Delms 2009). Flight stops the abuse and emotional damage hence knowing when to move on is imperative.

Teresa fell prey to her bullies, and the time came when she was unable to function, even in her own home. The demands at work and at home with teenage children combined to promote feelings of helplessness, inadequacy, and disappointment. It was not until she started to write a letter of finality to her family and attempt to take her life that she realised she was about to tip over the edge. She stepped back to evaluate her position and realised there had to be a way out and something had to be done. Gradually, she began to take control of her circumstances.

Jackson, Clare, and Mannix (2002) articulate that hostility towards a person can sometimes be the beginning of abuse. The authors emphasise that this needs to be addressed or it can spiral into more severe forms of intimidating behaviour, which can be premeditated and nasty. Bullying managers generally lack people skills and, as a rule, 82

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are very insecure people. For some reason, they also feel they are rather untouchable, and no one dare threaten their power. In these cases, the top tier of management should intervene, play an objective role, and act in a fair and reasonable manner. Instead, managers support each other, and the cycle continues. Hence, bullies breed bullies.

The experienced bully will strategically plan to involve other employees in the crime. Sometimes scheming will take place, as in the case of the boardroom meeting with Teresa. Unfortunately, a wall of silence is often created to protect the bully, irrespective of the severity of the act, nature of the intimidation, or the extent to which the victim is distressed. An example of this wall occurred when Teresa had the embarrassing accident following Agnes’s threatening visit and the extreme confrontation that followed. In the report that trailed that eventful day, the account or the consequences following the verbally aggressive visitor was never mentioned. Primarily the incident was not resolved, the absence of a conciliatory response to the barging in of team leader with close to nil consideration given to Teresa’s circumstances following a long weekend, set up a rocky foundation for any form of conflict resolution. Clearly the ground breaking incident on the 13th of June should have been confronted and arbitrated, as that was the start of Teresa’s emotional downturn.

In most instances, senior managers integrate behaviours to form an emotional wall. As a result, they protect the bully instead of the victim. For some reason, they see that they should protect and cover up instead of support or arbitrate. Their allegiance lies with the leader and not the victim. More often than not, the introduction of independent interveners very soon become corrupt and biased.

Intentions might be noble initially, however due to the fact that the independent or objective person is constantly in the midst of the opposition bias sets in.

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This was the case with the educator, who was included as a part of the team managing Teresa’s case. When Teresa first met her, she was pleasant. Her manner led Teresa to believe that her role would be that of mediator and she would eventually assist in resolving the situation. Initially, she seemed congenial and unbiased, but not for long. She soon joined the “bully club.”

The general consensus is that bullies invariably pick on nice people and look for vulnerability. They take pride in creating tension.

They sometimes find it amusing to get a certain reaction when they throw their weight around. One author says, “If it makes them happy being nasty to others then they have very sad lives” (Radcliffe 2007).

Covert bullying in the workplace goes unnoticed, it can be very subtle. Unfair criticisms or dismissal of opinions is commonly perpetrate, covert alludes that the victim is unimportant and sometimes, even passed off as a joke. The ideal treatment to ruin ones self esteem. Over a period of time, this can be humiliating for the victim. At one time, Teresa was selecting a smaller-sized top than her manager recommended.

Her manager said, “You don’t want a top that will show off all your lumps and bumps, do you?”

Teresa struggled with that comment for days. Even now, she flinches when she remembers those hurtful words that hit a raw nerve.

One author refers to bullying as “the silent epidemic of nursing” (Randle 2006). Other experts in the field claim it is pandemic (Roy 2003). This notion is very confrontational, considering it refers to a profession based on caring and humanitarian work.

In the past fifteen to twenty years, bullying has become more of an issue, and this trend is increasing. The matronly nurse of the sixties and seventies was stern and had a reputation for having 84

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a typical kind of personality; however, this type of nurse valued competence, knowledge, and hard work. Furthermore, they gave credit when credit was due. Rosters were centralised, so bias was not involved when it came to rostering. Teresa, who trained in the seventies, experienced sternness and intimidation as did several other nurses; however, the persistence of covert bullying seemed absent. Hard work was appreciated, and teamwork flourished.

Leaders and administrators must strive to stamp out bullying.

Stringent guidelines must be set in place to clamp down on this breed of nurses, who need to be held accountable. The victim of bullying is not the bad person here.

One manager said flippantly on one occasion, “The boss is always right.”

That attitude goes hand in hand with power. It is imperative, therefore, that all tiers of nursing are held accountable for their actions. It seems that middle management is the main culprit for this act of criminal behaviour. They want to be in complete control of an individual, and senior management sits back and lets it happen.

Bullies look for reasons to pick on their victims. There is a grain of truth in allegations… but “only a grain,” according to Boscarino and Figley (2004). Shrewdly, this is used to fool the onlooker or bystander into believing that the criticism has validity. Of course, the issue behind the criticism, based on distortion, misrepresentation, and fabrication, is trivial. With repeated accusations and trifling blame, the victim soon finds himself or herself unproductive, forgetful, and unglued.

Criticisms are used as a refusal to acknowledge contributions and achievements or recognise existence and value (Delms 2009).

The constant attempts to undermine position status, worth, value, and potential start to become unbearable. When in a group at work, 85

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the person is singled out and treated differently, and every error that is made, however trivial, results in an action. Being isolated and separated from colleagues, excluded from goings on, marginalised, overruled, ignored, belittled, and shouted at—especially in front of others—becomes common practice for the bully and a curse for the victim. Work often overloads the victim, or work can be taken away and replaced with menial tasks like filing or photocopying.

When Teresa first began working with her, the bully manager from the primary health care service would throw letters her way to place in envelopes. Teresa had to summon a lot of courage to subtly put her foot down and refuse. Interestingly, Teresa was more qualified than her manager, a chief reason why managers put down their subjects. One day, when the manager placed the envelopes and letters on Teresa’s desk, Teresa decided she must stop the demeaning behaviour, so she left the envelopes and letters untouched. Stuffing envelopes was certainly not in her job description.

When the manager returned and found the task had not been performed, she completed it herself and seemed a bit annoyed.

While she said nothing, her indifference towards Teresa following the incident said enough. The same manager berated Teresa in front of people over a trivial issue following a seminar presentation that Teresa gave at a conference. Teresa had brought a patient file (pertinent to the program but not as extensive as a medical file) and failed to mention it to her manager. While it was not the right thing to have done, the reprimand that followed in the presence of quite a few people was done to show authority and to humiliate Teresa. The presentation had gone very well. Teresa had excellent, comprehensive slides, and overall, all nurses at the forum received the talk well.

The incident of her manager’s outburst left Teresa with a sense of ambivalence. While she enjoyed the kudos at the success of the 86

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seminar, her jubilation was short-lived as the wrath that followed the careless use of a file without permission overshadowed the success of her presentation.

A classic area in which bullies can sink their teeth is the control of annual leave approval. In one instance, a peer was instructed to bring her leave forward so Teresa’s leave could be refused her request for annual leave, and because the peer came up with a reason for leave no more important than Teresa’s her leave was approved, instead of Teresa.

This was the start of a major breakdown at the workplace for Teresa.

Most bullies are inconsistent. They set unrealistic goals, are masters at dramatising events, frequently move the goal post, and change deadlines at short notice without the courtesy of providing an explanation.

Bullies are predatory and opportunistic. The victims they choose are usually those who are popular with colleagues, have a welldefined set of values, are charismatic, and demonstrate integrity.

Bullies despise integrity and see vulnerability as a weakness to be exploited. They exhibit jealousy towards the independent person who thinks for herself rather than follows others.

The bully is resentful if the victim is popular or the focus of attention. (This often occurs with female bullies.) Teresa was popular with almost all the people with whom she worked. The doctors and other allied health professionals loved her happy-go-lucky personality. In some ways, Teresa’s popularity kept her going. Most bullies detest personal qualities such as popularity, competence, intelligence, honesty, and integrity. They resent the fact that their victims are incorruptible, have high moral standards, and are well spoken and articulate. The bully tends to be immature, craves attention, is envious of abilities, jealous, of relationships, and is inadequate in most areas of interpersonal relationships.

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4.9 Consequences and solutions A review of UK nurses found that 25 to 48 per cent of nurses suffered from symptoms of psychological disturbance ranging from depression to suicide. Emotional exhaustion resulted from situations that unsupportive managers exacerbated.

Murray (2008) stresses the idea that workplace bullying in the nursing profession is a growing problem and should not be ignored.

It must be dealt with to move forward, emphasis must be placed on adopting a model of zero tolerance in response to any form of intimidation. Forty-one percent of nurses who have been bullied identified that their immediate supervisor or manager was the main culprit (Sweet 2005).

Advances in Contemporary Nurse Education (2009) brought the principles of restorative justice to the forefront. This approach was sought to foster active responsibility for addressing issues of concern by building social relationships in the workplace. Given the importance of the socialisation process through mediation, restorative approaches are proposed as a strategy to be implemented in nursing education to address the problem of bullying. That is an ideal place to start. Education is the beginning of addressing an issue. There is enough evidence to confirm the fact that bullying is real; hence, it must be confronted, brought out into the open, and no longer swept under the carpet.

Like any other nurse, the new recruit needs to be equipped to deal with this potential problem. Bullying must be confronted and dealt with if a resolution is desired. While one does not want to cause alarm in the classroom, there is a moral obligation to address a potential problem and equip budding nurses with tools to deal with the issue. Furthermore, all staff entering an organisation should be 88

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informed of policies and protocols practiced by the firm/hospital in response to bullying incidents. They should be aware of any measures taken to prevent bullying. An organisation would require courage to include anti-bullying in a vision statement. New nurses should be made aware of this pitfall in nursing, but it must not stop there. Nurses need to be taught the necessary skills to deal with this dark side of nursing, and every organisation must be proactive in implementing a strong policy against bullying and harassment.

4.10 Stress The North Dakota Nurses Association published an article pertinent to today’s workplace, “The Many Dimensions of Stress,� that highlighted the human response to stress. It is without doubt that the experience of bullying can cause enormous stress, activate centres of the brain to cause a nervous reaction, and have lasting effects if the bullying continues. Many practitioners can relate to this situation and can confirm the reality of this blatant behaviour. The fight-orflight response is comprehensively addressed in the article, drawing attention to the sympathetic nervous system and its activation in the event of danger or threat (Benson and Klipper 1975).

According to Granar (2007), any problem, imagined or real, initiates the thinking part of the brain (cerebral cortex). This sends an alarm to the hypothalamus, which signals the sympathetic nervous system to go into high alert and release epinephrine and norepinephrine from the adrenal glands (Davis, Eshelman, and McKay 2008; Granar 2007). The release of epinephrine into the sympathetic system increases the heart rate and respirations, an increase in muscle tension and blood pressure follows. Metabolism 89

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is now geared to feed the working muscles to prepare for flight.

Peripheral circulation is guided towards major muscles. Pupils dilate, and hearing sharpens to trigger the fight or flight response.

If there is repeated activation of the sympathetic nervous system, long-term negative effects could be the end result (Davis, Eshelman, and McKay; Granar).

Signs of stress include an increased heart rate and/or rate of breathing (hyperventilation), sleep disturbances, depression, preoccupation with the trauma, apathy, loss of appetite and/or faith, poor quality work, task avoidance, low morale, and burnout (Boscarino et al. 2004). Teresa experienced almost all these described symptoms.

It is believed that burnout is responsible for a high turnover of staff and there is a direct link between nurses experiencing physical, emotional stress and burnout. Physical stress can be managed by relieving pressure and workload. However, with regard to emotional stress, the emphasis should be on stress management, the aim being to reduce the triggers or avoid its occurrence. The human response (fight or flight) has now become one of the main factors contributing to poor health (Seaward 2006).

Psychological harassment and emotional aggression are closely related to bullying, intimidation, lateral violence, anger, agitation, and oppressed group behaviours (Boscarino et al. 2004; Cleary et al. 2010; Stevens 2002). Stevens believes the common reason for this aberrant behaviour is oppression, a controlling environment, and feelings related to a lack of control by the nurse in the workplace.

This leads to anger, agitation, frustration, and aggression.

Quine (1999) reiterates what other authors have said. Bullying constitutes behaviours such as accusations and nonverbal body language: glaring at or ignoring the victim, gossip, yelling, 90

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humiliation, the frequent assignment of undesirable tasks, withholding of information, and even physical threats. Consequences include escalating those feelings of anger and shame in the victim, carrying serious implications for recruitment and retention.

Organisations face serious issues as sick leave escalates, productivity reduces, errors increase, and teams begin to fall apart.

Administrators should assess the organisational structure and take action immediately. When bullying or intimidation is reported, it should be considered a serious offence, and guidelines must be established. Arbitrators should not become corrupt by acquiescing to the bully’s demands. There must be an objective approach and fairness. One-third of bullied nurses take more than fifty days off a year (Farrell 1999). Staff turnover rates of 28.4 per cent forced one hospital to take action in Australia (Stevens 2002).

Investigations reveal that bullying tactics are rampant at almost every level of nursing. In one hospital, daylong workshops were held for supervisors Stevens (2002). Information on conflict resolution and performance management was introduced. There was obvious denial and resistance, but anti-bullying policies and practices were instituted.

The outcome was a significant reduction in turnover. (Well done!) The managers at the highest level (director of nursing and assistant director of nursing) had the grit to stand up for justice. It is at this level (the highest) where change needs to be instituted if results are expected.

4.11 Pathophysiological process of stress Sheehan (1996) discusses the idea that violence or abuse affects people progressively. Most people transition through three specific stages until they are no longer able to deal effectively with their 91

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emotions, their environment, or even their job. The three stages, which comprise a multitude of symptoms, follow: 1. Active fight-or-flight is engaged. This includes reduced selfesteem, insomnia, anxiety, low morale, and eating disorders.

2. Neurotransmitters become depleted with a lack of sleep and fatigue. The brain is over stimulated and oversensitive, resulting in difficulty with emotional control, bursts of tears or laughter, irritability or unexplained anger, lack of motivation, burnout, hypertension, and apathy.

3. Brain circuit breakers are activated. The associated classic symptom is the inability to ignore issues that were manageable before. Changed response patterns superficially resemble a change of personality, disconnectedness, depression, impaired personal relationships, removal of self from the workplace psychologically and physically (sick leave, stress leave, resignation), and suicide (successful or attempted).

Teresa struggled through the three stages discussed by Sheehan.

Some days were better than others. She found that her worst days followed meetings, emails, and phone calls. Her main symptoms were insomnia, irritability, depression and low self esteem. She also felt she was unable to support her teenage children through this time, which brought on feelings of guilt (a regret she struggles with even now).

It is opportune to discuss the hormones that influence the stress response. Sood (2012) and Klein (2013) discuss the chemical reaction that takes place during a stressful situation. Adrenaline and epinephrine are referred to as the fight-or-flight hormones, the hormone cortisol is released later in the cycle. The adrenal glands 92

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produce adrenaline and norepinephrine after receiving a message from the brain that a stressful situation has presented itself.

According to Sood (2012), adrenaline and norepinephrine are largely responsible for the immediate reactions we feel when stressed. The primary role of the two hormones is to cause an alert and become more awake and focused and, as a result, more responsive.

Cortisol is a hydrocortisone hormone produced by the Adrenal glands in the kidneys, however its release and control comes from Adrenocorticotrophic Hormone (ACTH) in the hypothalamus of the brain. It takes a little more time—minutes rather than seconds—for its release and to feel the effects of cortisol in the face of stress because the release of this hormone is a multi-step process. (Sood 2012).

Sood (2012) also adds that oestrogen and testosterone affect how we react to stress. In a report from the Mayo Clinic (2009), longterm activation of the stress-response system—and the subsequent overstimulation of cortisol and other stress hormones—can disrupt almost all body processes. This increases the risk of numerous health problems, including heart disease, sleep problems, digestive problems, depression, obesity, and memory impairment.

The clinic confirms that adrenaline or norepinephrine and cortisol, or hydrocortisone, are stress hormones secreted from the adrenal glands, which sit above the kidneys. Though both chemicals—adrenaline and cortisol—are stress hormones, they play different biochemical roles. Adrenaline primarily binds to receptors on the heart and heart vessels and hence increases the heart rate, the force of muscle contraction and respiration. Cortisol, on the other hand, binds to receptors on the fat cells, liver, and pancreas, which increases glucose levels and is available for muscles to use. It also temporarily inhibits other systems of the body, including digestion, growth, reproduction, and the immune system.

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Chronic stress is an umbrella term that refers to continuous physical or psychological forms of tension and pressure and is directly linked to chronically high blood concentrations of adrenaline and cortisol. The Mayo Clinic suggests that heart attack and stroke may lead to structural alterations in the brain’s memory and fearprocessing centres.

It is interesting to note that high levels of stress hormones have been associated with an increased risk of cancer, as well as an increased chance for existing cancer to spread. Normal cells that become detached from tissue quickly die off (Sood et al. 2010).

Cancer cells, however, are protected from cell death in the presence of the protein FAK. The researchers found that adrenaline activates FAK, allowing more detached cancer cells to survive until they can reattach in a different region. Hence, stress can promote migration of cancer and cause secondary cancers, a revelation worth taking note of, and a logical argument that warrants stress to be under control in one’s life.

FAK is a tyrosine kinase of the FAK protein family required for cell migration. It hangs around adhesions between cells growing in the presence of extracellular medium and interacts for full transformation of fibroblasts (cancer cells). In other words, it enhances the progress of cancer cells. Increased activation is consistent with increased migration invasion and progression of breast cancer, ovarian cancer, hepatocellular cancer, thyroid cancer, and acute myelogenous leukaemia. Medical treatment for prolonged high levels of adrenaline and cortisol include treatment with betablockers and anti-anxiety medication. These consequences of longterm stress are extremely sobering (PhosphoSitePlus).

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4.12 Conclusion It is worth emphasising that training needs to be provided for all leaders. Just as infection needs to be controlled at the bedside by primary nurses, so should leaders and managers control bullying and intimidation by fair, reasonable, and objective management of nurses. While nursing has progressed academically, the profession has fallen short of integrating the pragmatic side of nursing to cater to the needs of the nurse at the bedside. It is important to draw together strategic plans to strengthen the nucleus of nursing (patient care). The problem is that all senior nurses and bureaucrats strongly believe they are the pivotal point of the profession, and that very notion gives them power.

What kind of person would want to be a nurse? What qualities would draw a person towards a caring profession such as nursing?

The textbooks tell us that a global shortage of nurses is a worry.

However, unless governments and senior management recognise the drawbacks and hindrances to practice nursing in a safe and friendly environment, the profession will be left in ruins, causing a continuous high demand for nurses with a limited supply to offer.

The profession will continue to deteriorate, and nurses will continue to leave in droves.

In the case of Teresa, the demands that she commute between the beachside and big hospitals continued. Teresa, however, believed she could not possibly work under the scrutiny of the very people who were bullying her. Not only was it degrading, it was an unnecessary waste of time and an unlawful use of power. She flatly refused to go to the big hospital and to succumb to the team leader and the manager as they looked over her shoulder. Teresa knew full well that the same work could be completed in her own small beachside workplace, 95

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regular visits from the manager or team leader would ensure that work was completed, furthermore the fact that the data base was accessible from any of the five hospitals would enable supervision of the process of data completion / entry.

As mentioned, some days were better than others for Teresa.

When she was low, she was barely able to get out of a chair. She would walk around with her husband’s antihypertensives in her pocket. Her two younger children, fifteen and thirteen years old at the time, were quite distressed by their mother’s gradual emotional deterioration.

Sadly, neither of the parties in the workplace would give in. Teresa believed she was being unfairly treated and felt that, if she were given time, with the pressure of meetings and abusive behaviour removed, she would be able to get on top of the work.

Certain staff members were supportive and helped her get through some difficult days. Her office buddy observed Teresa at work and expressed a high regard for the quality of her efforts. The occupational health officer and some of the other leaders in the hospital, were understanding as they saw the outcomes of Teresa’s contributions.

Totally disillusioned by her professional experiences over the last ten years, as well as her most recent difficulties, Teresa decided to act on a thought she had a couple years earlier. She would seek a position in a different country and make a change. In this instance, she chose the devil she did not know instead of the one she did. Her logic was to experience a different culture, position, and perhaps some adventure. Would this move take Teresa from the frying pan into the fire? Only time would tell.

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CHAPTER FIVE

A New Beginning…

And an Old Problem

The plane began to taxi down the runway. Teresa settled into her seat and tried to focus on the stewardess’s gentle, comforting voice as she meticulously went through the safety procedures. Teresa’s thoughts were on what lay ahead. This is it! I’m on my way to challenge, mystery, and adventure!

She had decided the future took precedence over the present. oblivious of her surroundings, she hardly took notice of the elderly lady sitting to her side, struggling to click her seatbelt in place. The uncomfortable shuffle drew Teresa’s attention. She turned to the woman, apologised, and lent a hand with the seatbelt.

She began to reflect on the hour leading to her departure and the good-byes. To some extent, she was glad they were over. Well aware that tears and departing phrases would have lasting memories, Teresa shifted in her seat to get comfortable. She had felt moved by the genuine affection, concern, and caring displayed by her family. She knew they were not very happy about her drastic move to Saudi Arabia. However, 97

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they all understood that she was close to a breakdown and needed to get away to kick-start her professional life.

Not sure if it was a good idea, Teresa decided to take a chance by assuming a new nursing position in the Middle East. With the reluctant blessings of her husband and children, she had set off to take on a charge nurse position in a hospital that specialised in cardiology.

She realised the world of nursing she was about to step into was about to fulfil a self-proclaimed prophesy. One day, she would work in extreme conditions. At the ripe old age of fifty-three, she was determined that this professional adventure would compensate for some of her recent experiences in nursing and provide a loophole for travel to nearby countries. Or was it simply an escape?

Whatever the reason, she knew the change had to come now or never. In the past, she had occasionally thought about the prospect of work in this country of great wealth and strict regime. Now, it appeared, was a good time, as nursing in Australia was a let down.

She could not bear the thought of stepping into another Sydney hospital to take on a permanent position. A change is “as good as a holiday,� her counsellor advised her, and she was right. With a sense of challenge and excitement, she boarded the plane to head off to a land that was, according to Western standards, controversial in its beliefs and practices.

The stewardess concluded her explanation of the safety procedures. Teresa was lost in her thoughts of separation from the world she had grown to love and appreciate and the husband and five children she loved dearly. She asked herself what was she doing, moving to the other side of the world to a country that, for her, defied all logic, comfort, and freedom. However, she argued with herself, you can sometimes live in a free environment but still feel imprisoned or be in a crowded room and still feel lonely.

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One thing was clear. She needed a change. The answers would hopefully unfold as she proceeded on this journey. Her thoughts drifted to the final moments before she said her good-byes. Martin Senior had prompted, “It’s ten thirty. Your mum should really be going.” Blowing one last kiss and casting a last look at her family and dear husband, whose figure had become blurry now through tears, she walked down the corridor to fill in forms before proceeding through customs and boarding the plane.

Thoughts of doubt, confusion, and apprehension began to flood her mind as the plane gathered speed along the runway and lifted off the ground. She had always been fascinated with the technology that made it possible for a massive plane to take off and soar high into the sky. The A380 almost felt like the Queen Mary lifting up into the clouds. She removed herself from thoughts of the future, for a short moment, as the marvel of flying mesmerised her.

The thought of nursing in Saudi Arabia seemed like the ultimate adventure, one that would bring an enormous number of challenges.

It would provide alternate relief from the Western style of nursing and expose her to a culture considered a rigid, global regime on multiple levels.

The tough times in her previous place of employment—in fact, over the last five or six years—became a watershed for Teresa’s decision to go to a place where her skills would be appreciated, or so she thought. Her work life gradually came to a grinding halt. She knew that, if she did not change what she was feeling and refocus, some serious emotional and psychological damage would follow.

Warning signs were becoming more apparent, such as her being unable to perform productively in the workplace. Finding other jobs made matters worse. She was not able to settle and remained unhappy. She firmly believed that she needed a change. Much to the 99

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dismay of her family, she pleaded with them to let her go and thereby empower her to break the cycle of disappointment and despair that threatened to dismantle her professional life.

After working for thirty years in the public health system, the lack of gratitude, support, and fairness seemed to penetrate the core of her very being. The victim of repeated lies, slander, bullying, and intimidation over a period of five years, Teresa had been forced to take the drastic step of moving and working overseas.

Her counsellor thought it would work. She advised, “Do not isolate yourself. Mix with others, and make an effort to establish friendships.” Teresa would remember this advice regularly over the next few months.

After an initial reaction of shock and horror followed by an attitude of disapproval, Martin gave Teresa’s plan considerable thought before mellowing and ultimately sympathising with his wife’s decision. He knew Teresa was struggling emotionally and had lost a lot of self-esteem. As always, her husband had taken time to reflect. When given logical arguments, he would usually come around, and on this occasion, he did. He and the two youngest children had seen Teresa’s state when she came home after work on some days, and they were quite distressed at the change that had come over their fun-loving, happy-go-lucky wife and mother. Her family knew that Teresa would take these measures only if she had a good reason.

Her mind wandered back to the reaction she received when the news of working overseas was first delivered. Approval from the most important person in her life was vital. The subject was initially raised twelve months earlier, at the time he had not wanted to hear about it. Other attempts to discuss the matter were received with a roll of 100

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the eyes or a frustrated raise of the hands, along with the comment, “This is getting stressful.”

Martin was adamant that it would not be in Teresa’s best interest to go to a place where life could be more difficult than it had been in Australia. Aside from the separation and the distance, there were safety issues to consider. Finally, eight months later, the seriousness and determination in Teresa’s voice forced him to relent and listen.

Following much discussion, the man she loved had not only given his approval but had also expressed an interest to join her following her three-month probation. At the interview, she made it clear that she needed her husband to join her. The position of charge nurse was offered with a package that allowed partners to join the employees. Martin was pleased to find out that she would make the transition on the condition that he would be allowed to join her in Saudi Arabia.

As she battled with feelings of hopelessness and low self-esteem, she decided that going elsewhere would allow her to fulfil her long time dream to travel and to see Europe. The continent was rich in history and convenient because of its geographical closeness to Saudi Arabia, hence allowing the couple, as part of a travel plan, to embark on a holiday that had the potential to turn events around and finally get away from the nightmare Teresa had been living.

The average person would consider that assuming a position as a nurse in Saudi Arabia would be a last resort and that Teresa would indeed be going from the frying pan into the fire. However, Teresa strongly believed that the extreme differences in lifestyle, culture, and—almost definitely—nursing would be exactly what the doctor ordered for her, a rather disillusioned and depressed fifty-three-yearold nurse. In fact, her counsellor had advocated the move, and a few extended family and friends commended her on the courage she 101

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possessed to just contemplate the move. She hoped the controversial style of living would create an atmosphere of adventure that would encourage her to explore this intriguing part of the world. She also was confident that the high standard of skills she acquired in Australia would be appreciated and embraced.

Clichés like “You’ll never know if you never go” or “No guts, no glory” rang in her ears and planted the seed of determination. She was well aware that making this life change would be a most difficult task, but she also knew her gut feeling. Go for it.

And so she did. She strongly believed the change would assist in completely taking her mind off recent issues and point her in a different direction, hopefully a positive one. The reasonable wage would help cover all necessary bills back home, and the remaining funds would allow her the flexibility to experience history and see the most ancient of relics in the world. Dear God! She hoped she had made the right decision. It was too late to turn back now. She was on the plane now and heading across the sea to a strange new land.

The plane proceeded to soar into the far open space, and the apprehension began to surface. Trying not to dwell too much on the negative, she transferred her thinking to all the research she had done prior to exploring the possibility of working in the Middle East.

She had spoken to several people and read literature. She decided that, if she followed the principle, “When in Rome,” her life would be devoid of hassles. The discipline and structure of the country would become a part of the adventure. The Saudi’s commitment to religion was something she admired and respected. She reflected that, if Christians were true to their beliefs and practiced what the Bible taught, their lives would be less complicated, and all human beings would live in harmony.

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The children were overwhelmed with their mother’s decision to work overseas. Martin Junior, the youngest, nearly seventeen at the time, said, “Mummy, I understand the reason you are doing this. I know you have a lot to give to nursing, and deep down, I realise this is what you really want to do. You have been really unhappy, so I am going to be happy for you, but I will miss you so much.”

The plan was to have his dad remain in Australia throughout the intense study periods of high school to see him through.

Teresa’s four daughters were quite independent and took their mum’s decision in stride. They seemed to be happy for mum, but they expressed some concern. Her eighteen-year-old, Sasha, was an extremely capable and disciplined girl who was focused on her studies through exams and achieved well in her final year at school; however, she had some trouble in deciding what to do following the completion of school, such as not knowing what studies to take on at university or whether she should travel. Hence, she deferred university studies for twelve months. Her parting words, through tears, were, “Mum, if you are unhappy, do not feel you are a failure if you decide to return to Australia. Please, you are brave to even contemplate the trip.” Teresa would remember these great words of encouragement in later days.

Tina and Rachel second and third daughters who were twenty four and twenty one, were obviously concerned about their mother’s safety. However, they were happy to support their mother in her desire to experience a different culture, and they hoped that job satisfaction would be the end result. On initially hearing of Teresa’s decision, they were a bit shocked and thought the move was quite radical; however, they knew their mother’s determined nature when it came to making decisions, and were aware that a lot of thought would have gone into the planning process before action took place.

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Therefore, their response was, “Okay, Mum, if that is what you want to do.” Before, they asked all the appropriate questions, such as, “How long will you be away? What position have you been offered?

Will you be safe? What about your living conditions?”

Her twenty four year old Tina was engaged to be married and would have liked Mum to be around while she planned her wedding.

She needed reassurance that, with Skype, emails, and regular holidays, the problem could be overcome. While Tina thought it would be tough, she relented and gave her mum her blessing to go.

The eldest, twenty-six and married, was over the moon with excitement about Teresa’s decision. Her response was typical of the Y generation, who valued travel and seeing the world. “I will come and visit you, Mum. I am so excited for you!” She secretly wished that she was the one on this plane, heading off into the never-never.

The plane was well and truly on its journey. The movement of human traffic in the aisles and smooth flying gave Teresa the feeling of being on ground rather than miles high in the air.

The plane continued to head across the globe. All the passengers were settled. The service was good, the crew, friendly, and the captain courteously vocalised his friendly greeting to all passengers, providing updates from time to time. People stopped to listen when the captain spoke. Even the baby who was whimpering on the side since take off stopped to take in the distinguished voice. The captain’s accent added a certain level of mystery to the welcome. Teresa was sure voice and speech were essential criteria when it came to piloting a plane.

Several friends inquired why a fifty-three-year-old would leave her family, children, and hubby to go and nurse in a strange country with unique beliefs and customs. She pondered this question repeatedly. Nursing was not for the fainthearted, and after some thirty years of working, Teresa had many unanswered questions.

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Where was nursing going, and why were role definitions no longer clearly outlined? Boardrooms were constantly booked to run meetings and introduce new policies. Leaders no longer made trips to where the action took place (the bedside), but they believed they were capable of making important decisions while sitting at a desk or gazing at a computer screen relying on subjective information reports from subordinates. Unfortunately, thought Teresa, the real place where it all happens is neglected.

The opinions of real people at the forefront and in the core of hospital care were dismissed. Egos were big. If one challenged nursing practice or behaviour or stood up for oneself in an abusive situation, adversity was to be expected. Assertive nurses would find themselves being bullied and intimidated into silence so they could be put in their place. Basically, at a tier level, nursing management could do what they like and are well supported by seniors who either turn the other way or pretend a problem does not exist.

Teresa’s plane was nearly at the end of the first half of its flight.

This move to the Middle East was an attempt to bring to the forefront her professional self-esteem, and to build a bridge that had collapsed through experiences in the workforce that had stemmed from bullying, harassment, and intimidation. Teresa took on this journey to turn a negative experience into, hopefully, a positive one. She needed to confirm to herself that, deep down she was a good nurse.

She also needed to rekindle her love for nursing.

Teresa continued with her train of thought. Attention needed to be drawn to organisations in an effort to encourage them to value their nurses and take heed when victims of bullying claimed that phone calls, emails, and so on have been abusive. Management must believe these victims and take action. Objectivity is crucial when dealing with conflict.

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The neglect on management’s part to take seriously bullying reports and be proactive to deal with accusations resulted in a smear campaign across the front pages of newspapers during the years 2006 and 2007 with the media intervening. In addition were accounts of medication errors and malpractice, one error causing death. These stories continued to appear in the media, alerting the public to the fact that we live in an unsafe, insecure public health system.

Bullying is a global issue. The fact remains that, when these adverse practices occur, the leader is always right. Even if they are not, their managers, will strive to get them off the hook and offer support, a whirlwind situation occurs with the core factor, the nurse who does the hard yards, faces the abuse of being forced into a corner and attends several meetings during which she is told how terrible she is.

The brief stopover in Singapore was enlightening. The glitz and glamour of the airport greatly reduced the apprehension she was experiencing. She felt somewhat content as she sat in a noodle bar, sipping a glass of wine and seriously contemplating her next move.

She was fully aware that this was possibly the last glass of wine she would enjoy for a long time.

She nervously boarded the plane for the remainder of her journey.

Confronting was the fact quite a few women covered from head to foot, their eyes peeping through their face veils. A few Westerners were on the flight. Not enough, however, to make her feel that she was on familiar ground. The prayer before take off made her sit up and take notice. Allah aur Akbar, Allah aur Akbar. Followed by a few more words in Arabic. The words sent a slight shiver down her spine as reality set in. She knew this journey was of her making. There were many variables to take in. This strange experience would be the first of many.

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The second half of the flight seemed shorter, probably because she had a sleep on the plane. Travelling against the time meant she was well into the night of Australian time, so even though it was 7:00 or 8:00 p.m. Middle Eastern time, it was 1:00 a.m. Sydney time.

The plane began to descend, and before long, it was taxing into the chute. Several non-Muslim ladies put on abayas, long-sleeved, black, cloak-like garments to be worn over normal clothing, the traditional dress worn by Muslim women in the Middle East and enforced in Saudi Arabia. Along with that, it is expected that a scarf will be worn to cover one’s head, though the enforcement of covering of the head has become more relaxed in recent years. Saudi Arabia is the only country in the Middle East that enforces this type of dress.

Teresa did not have an abaya yet; however, she was dressed modestly with her arms well covered and the hem of her skirt brushing her ankles.

Passengers were disembarking. overhead luggage, was gathered and very quietly they proceeded to leave the plane. The sight of men dressed in military uniforms and armed with machine guns made Teresa feel like she was in a war zone. She proceeded, all the while pretending to be unaffected by their presence and saying to herself, I hope I have made the right decision.

The ladies’ line, separated from the men’s, was another confrontation, a difference, she was about to face on a regular basis. Reading and hearing about a culture is so different from the experience itself; she told herself as she lined up with other female passengers.

After another official stamped and signed her passport, she walked through the heavy gates to collect her luggage. At this point, she met two Australian girls, who, it seemed, were heading in her direction. Perhaps we are going to the same hospital. She would stay 107

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close to them. She managed to get through the gates while the girls were having trouble with their luggage, which, apparently, had not followed them from Singapore.

In the waiting area, Teresa clung to her luggage, knowing these personal items were the only ones familiar to her. The two Aussie girls were a bit perplexed and annoyed that their luggage had been left behind in Singapore, a regular occurrence with international travel but very inconvenient for the traveller.

Although it was 4:30 a.m. in Australia, Teresa decided to call Martin. He was relieved to hear her voice, and she was so happy to speak to him. They discussed the general topic of flight and safety before she reluctantly called off to focus on getting to her final destination, her new home.

The two girls joined her with a hospital official who guided the three to a minibus. The driver by its side, spoke no english, was dressed in loose Arabic clothing that was white at some stage of its life. The middle aged man with a long partial grey beard gave the girls a stern unfriendly look. The heat struck them in a way that they had never before experienced. Even at midnight, the heat scorched their cheeks. Grasping her suitcase, Teresa entered the van with the two girls. The official spoke a few words to the driver, and they set off to their accommodation.

She soon discovered that the other girls were indeed heading in her direction. One girl was from Queensland, and the other was from Sydney, not too far from where Teresa lived.

As fate would have it, fifteen minutes into the journey, it became apparent that the driver was lost. He made several stops and calls on his phone, and his voice became agitated and irritable. The girls made light hearted, comments about adventure and surreal experiences.

All three wondered what they were doing in this nearly forbidden 108

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country, where they would be socially excluded from the Western world. The conversation went from light hearted tones, to concern that they would arrive safely at their accommodation, the agitation in the driver’s voice reassured them he was genuinely lost and this was not a trip from which they would never be heard of again. Eventually, they arrived at their final destination, the compound that was to be their home. The trip that should have taken forty minutes had lasted an hour and a half.

Barbed wire fortified the high walls that surrounded the compound, a discovery that chilled Teresa to the depth of her being.

She felt a prisoner here with the two girls, Amanda and Emily; she kept these feelings to herself. The manager of the accommodation was present to meet the girls and walked them through a range of villas, strategically built opposite each other and separated by a flashy fifty-meter pool that gleamed with underwater lights. The interior surroundings were as friendly as the exterior was not. They entered an impressive, reasonably spacious, and comfortable villa. Soon it became clear that the three girls were to share one house. Raj, the accommodation manager, stated that the villa had three bedrooms.

“Teresa will have the master bedroom because she has the position of charge nurse,” he commented before advising, “Get some sleep. You will be picked up at nine to be taken to the hospital.”

The girls, commenting on the experience so far, dragged themselves to their bedrooms. While Teresa secretly felt glad she scored the master bedroom with the king-sized bed and en suite, she almost felt embarrassed that the other girls had to rough it out.

The next morning, the girls were up early, dressed and waiting to be escorted to their place of work. The TV was televising the funeral of Michael Jackson. Brooke Shields was making some nostalgic, emotional comments on the legend, a sad loss to the world of music 109

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and dance. Feeling sleep-deprived, Teresa proceeded to head off with her roomies to get on her way. The day was hot and already felt like 40 degrees centigrade at nine in the morning. The climate was a major adjustment, from the low temperatures and high winds Sydney experienced in the depths of winter days to the searing temperatures and scorching sun of Saudi Arabia.

The hospital was forty minutes from the compound. As they drove along, the girls played a game looking for grass or lawn amidst the desert sand and buildings. The traffic was heavy, main roads wide and the speed at which they were driving seemed faster than back home in Australia. The girls were taken to the administration block to complete several forms and have their passports taken, another confrontational moment. As she felt her freedom slipping away, Teresa shifted uncomfortably. Her agent had advised that passports would be confiscated, and returned when international travel was next on the agenda. Despite knowing that, the reality of the moment caused some apprehension.

Lunch was next on the agenda. The cafeteria was big, and males were separated from females. As expected, the males had a better seating arrangement. The food, a cross between Indian and Middle Eastern cuisine, was reasonably priced and very different. There was the distinct fragrance of curry, but also aromatics like cinnamon and cardamom, cumin, turmeric, and aniseed had been blended into some of the meats. The stew appeared to be slow-cooked and oozed with a flavoursome sauce and colourful vegetables. Between the atmosphere and, lurking in the background, the smell of biryani, the cafeteria was very inviting. Dry and dense textured flatbreads were neatly stacked beside a self-serve salad bar fairly large in size.

Teresa who, was not a great lover of the bread, was drawn to the salad bar, which was filled with trays of beans, asparagus, corn, 110

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coleslaw, baby spinach, and colourful lettuce leaves. She was fairly hungry after the last few uncertain hours and decided to go for the healthy vegetable options, but she also indulged in small servings of the biryani and lamb curry. Following lunch, the three girls went to their respective workstations.

Teresa met her immediate line manager and her counterpart, the other charge nurse, who would alternate days with Teresa to basically cover a seven-day roster of twelve-hour shifts. One nurse was leaving, and a farewell afternoon tea was in progress. A great spread of Asian food covered the long table, and a few people said their farewells. The masalama, as the Arabs defined, was soon over. Teresa spoke again to her nurse manager. First impressions were encouraging, and all were happy. This place could work, Teresa reflected as she observed the interactions between several colleagues.

It was not long before the director of nursing arrived for the farewell. It was an opportune time for Teresa to meet her and say hello. Originally from Asia, she introduced herself and spoke in a professional manner to Teresa. The girl who was leaving was popular, so it was with some sadness that staff waved her good-bye as she headed back to her homeland to get married.

That evening, Teresa and her roomies were taken to the souk (marketplace). Like all markets, souks offer many goods at reasonable prices. Accompanied by the kind nurse manager of the Coronary Care Unit, a British Aussie who lived in Brisbane, Australia, Teresa and her roomies went to purchase clothing that they would wear during the rest of their stay in Saudi Arabia. The girls would each obtain an abaya, accompanied by a shawl, which, by law, should be worn over a woman’s head whenever out in public, a practice the religious police called the Mutawa enforced. The practice was strictly enforced before 2005; however, following the terrorist attacks of 111

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Western compounds, it was believed that the attack stemmed from the influence of the fanatical religious police (Mutawa); hence, the government removed a lot of the power from them; therefore the law of wearing the scarf was not as strictly enforced. Following 2005, the Government’s move was to bring educated, broad-minded Muslims into the role of religious police. Many of these Muslims practiced professions like medicine and law, and would also oversee the law from a religious perspective. They were level headed, reasonable, well spoken and obviously the country also had the law enforcing police, who wore traditional police clothes and took care of other offences, political issues and crime in general.

The souk was interesting, very dusty, with lots of shops that offered some good quality items that could be purchased at a reasonable price. There were shops that sold goods from carpets to ornaments, furniture, perfumes, and even gold. Shopkeepers looked suspiciously as the girls walked by. Some were curious, and others were smiling, exposing a welcome element of friendliness. The shopkeepers at the roadside shops sold watches and cultural ornaments and were a bit more verbal in their demands for a sale, while the others seemed more reserved. For a marketplace, it was quiet. The three roomies felt a rush to get the garments they were looking for, as it was soon to be prayer time, and all shops would shut for a half hour, was not long before each selected a garment that will be worn over their normal clothes.

The next stop was the shopping centre to buy groceries. All the girls bought individual items and a few pots and pans. A busy day which finally ended at midnight. Teresa was beginning to feel a bond with Amanda and Emily. The shared experiences of the last twentyfour hours were beginning to create a connection between the three girls. They would share the villa for three months.

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Amanda, the youngest of the three moved out two and a half months later. Amanda was like Teresa’s eldest daughter, but looked much like her youngest. She was young in spirit and in heart. It was good to have her around. Teresa was sorry to see her leave. Emily, who was also much younger than Teresa, stayed another three weeks until suitable accommodation was available. Teresa enjoyed some great chats about family issues with Emily while they had the occasional late-night swim in the sparkling and pristine pool. Teresa met several other nurses from various parts of Australia and countries near Saudi Arabia. The women would shop together, have a coffee, go out to dinner, or just catch up for a chat at each others places.

She vividly remembers the young couple from Adelaide whom she regularly shopped with, had frequent friendly chats reminiscing, discussing home and life in Saudi. The young bubbly personality of Christine from Brisbane who was great to chat with on the bus or in the compound. The three young expats returned to Aus, have started a family and are sure to be richer for their experiences and travel.

Teresa’s life was enriched by the many other expats she met. The Irish and several others added to the experience of adventure and culture.

Teresa also met a young Indian family who had two gorgeous children. The family was originally from Hyderabad, migrated to New Zealand, and lived in the compound. Celina worked at the British school in finance section, and her husband Rob, worked for a phone company. They both had good jobs, and were quite settled in Saudi, in-fact when the Saudi Government changed the law of property ownership they bought a home and moved out of the compound. Their intention was to stay a lot longer obtain financial security before they went back to New Zealand. While they lived in the compound, she would visit them, and go shopping occasionally, Celina preferred shopping at the Souks instead of the big shopping 113

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centres, and Teresa welcomed the change. On one such occasion Teresa bought herself a unique designed Diamond ring from one of the souks, a piece of jewellery she will treasure and will always remind her of Saudi Arabia and her experience. The family were hospitable, and cooked the odd meal for Teresa in return, Teresa enjoyed the pleasure of bringing back little souvenirs from Sydney when she went for her regular breaks. Celina made a lovey cup of tea, was always a special treat to sip on tea and take the opportunity to reminisce on India, the land she left at nineteen years of age.

The hospital made the transition convenient by providing an advance in wages. With the financial assistance, the Internet was set up the next day. She must get communication going as a matter of priority. All international employees starting would get the benefit of the advance in pay, the generosity of the hospital was welcomed by most new recruits. There was a lot to learn, but Teresa felt she could overcome the demands of this new role.

As the charge nurse of an acute cardiology ward and unit, several challenges were awaiting Teresa. The workplace included an adult congenital unit attached to the nineteen-bed acute ward.

The acute ward was designed for patients who returned following coronary artery stenting, pacemaker, defibrillator implantation, and angiograms. Patients were also admitted with acute heart failure, and occasionally, if the cardiology unit was full, heart attack patients were brought to the acute ward to recover. Due to inbreeding, congenital anomalies were common, especially cardiac-related; hence, there was sufficient reason to have a unit just for those patients born with congenital cardiac defects, who had corrective surgery as babies or children but needed on going treatment and follow up care.

Most of the nurses who worked in the hospital were primarily trained in the Philippines, a country that trained more nurses than 114

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needed, and unfortunately had insufficient jobs and finances to employ them. To add insult to injury, the wages were extremely low compared to international standards. As a result, nurses would frequently leave the Philippines in search of jobs elsewhere. The Middle East was one such country.

Originally, the hospitals were mainly staffed with Western nurses. However, after the terrorist attacks on three compounds in 2003, Westerners fled and left a void. The opportunity presented itself for nurses, form the Philippines to obtain employment in the Middle East. It suited the Saudi government to recruit the nurses. The nurses would be paid less than Western nurses however more than what they would receive in their own country, the nurses had jobs, the Saudi hospitals were staffed; became a win-win situation. However, Western nurses were paid three times as much as the nurses from the Philippines. Wage discrimination did not sit well with some nurses; nevertheless, relative to their living standards, they were paid more than they would receive in their own country as a result they were able to live comfortably and support their families back home. In fact, their lifestyle had improved far more than that of the Western counterparts, as their standard of living was not as high. The taxfree salary had some benefits in terms of take-home pay. Therefore, in relative terms, the nurses from Asia were much better off. Despite that, the wage difference did not sit well with them. For example, the nurse manager, Teresa’s immediate boss, earned two and a half times less than Teresa did. The hospital benefited by paying less wages, and the nurses had jobs to go to, a situation that did not exist in their country.

The drawback was that the quality of nursing care was not up to Western standards. While the group of nurses worked hard in the strictly competency-based environment and studied hard to 115

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pass exams, putting theory into practice seemed difficult to achieve.

Critical thinking was never encouraged. The system was very foreign to Teresa. Her professional experience told her she needed to take it on board and make the transition to learn and adapt to the practice without compromising her own nursing standards.

A week into the job, Teresa became ill. It was the time when Europe was facing the H1N1 virus, or “swine flu.” The ward and several beds throughout the hospital were closed. Teresa’s illness began with headaches, which moved to a high fever and progressed to severe muscle aches. She went to staff health, was tested and treated for a virus. Though it was not confirmed by the extensive symptoms, she was positive that she had fallen victim to the illness.

She missed her family greatly but tried to get through this new emotional trauma. Following a week of sick leave, she returned to work. She still felt rather weak and unable to take on a new role and learn new practices. She was taken aback when, in the course of her first day back, her manager accused her of poor hygiene, stating it was the reason for her illness, the repeat of the very same experience from which she had fled.

Teresa took some time to recover. She continued to work but felt she was not able to perform her duties as well. Cognitively, she struggled, but she did not want to give up. She struggled through some competencies, and her manager was quick to point these out as shortcomings. She got through and reached the point where she was developing good relationships with some of the nurses she managed.

They liked her easy going, friendly nature. They appreciated and valued her emergency skills and assertiveness with different departments to look after the ward staff. The days were long (twelvehour shifts) but satisfying.

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There was always the difficulty of being able to work well with the manager, who seemed to find fault with trivial issues and would constantly make comments to Teresa to create a difficult atmosphere and environment in which to work.

The story would continue to unfold as Teresa discovered yet another bully in Saudi Arabia. As the saying goes, “what does not break you will make you stronger.�

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CHAPTER SIX

Back to Australia

As Teresa continued in her new role, most staff members were very respectful. The transition to her new environment and position was an ongoing process. Some learning was gained on the job, while some was acquired through trial and error.

On the home front, all was running smoothly. She was in regular contact with her husband through Skype or emails and the odd text message. The two younger children at home were missing Mum; however, school friends and social engagements took the focus off the fact that Mum was miles away.

She was soon to discover that not all would be respectful at her workplace. One day while on weekend duty, she faced the first challenge to her authority as a charge nurse. Two nurses took themselves off during work time to have a haircut without permission or informing anyone. It was not until they returned and were bragging about the good cuts they got that Teresa realised what had happened. Being in charge, the nurses’ actions disturbed Teresa.

She did not want a confrontation; however, she realised she could not let this offence pass without some form of comment or reprimand.

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Close to the end of the shift, she pulled the nurses aside and informed them that their behaviour was unprofessional and permission should have been obtained before they went to the hair salon, considering it was during work time. One person was apologetic, and the other was not sure what to say. Teresa possibly should have left it at that. Instead, she took the matter to her manager to inform her of the incident. She found it hard to believe that something like this could occur, but she hoped she’d dealt with the matter correctly. Unaware that one of the girls was a favourite, she disclosed the matter to the manager in the privacy of her office.

To her amazement, her manager turned tables on her and picked on slight errors she had made in the handover sheet. Teresa tried to reason with her manager in an attempt to draw attention to the lack of work ethic demonstrated by the nurses who had left the unit without informing anyone. Not long after the confrontation, Teresa observed that the role of one of the girls had changed on the roster.

She had been promoted to acting clinical educator. Neither Teresa, nor her counter part were aware of this change. Teresa could not comprehend that a promotion was granted to a nurse who had defied protocols and behaved in a deviant manner. What was even more disturbing was the fact that this insubordinate nurse would now be in a position superior to that of Teresa’s. Thinking that approval for this promotion might have come from senior management, she consulted with a fellow Western colleague who worked in Human Resource and lived in the same compound as Teresa. The colleague advised her take the matter to the deputy director of nursing, who was Australian and Teresa’s manager’s immediate boss.

As it turned out, the deputy director of nursing, Michelle, had no knowledge that this promotion had occurred. As far as she was concerned, “the clinical educator position was still vacant.” Michelle 120

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was surprised that the person was granted a position without approval from senior management. Diplomatically, she intervened, and the nurse was not given the educator role. Instead, the role was temporarily given to the other charge nurse, who was to fill the position until a permanent educator was hired. The charge nurse was not happy to take on the role the change took place while Teresa was on holiday, her first break since the big move. Teresa returned to Saudi from vacation to discover an extreme indifference towards her by her manager and the fellow charge nurse, worse than it had been before she left.

She strongly believed that, as was customary with all deputy directors, the matter would have been taken to the next person of higher authority, the director of nursing, who was corrupt when it came to dealing with this particular large group of nurses. As a result, the issue came back to Teresa’s manager. While this was only a suspicion, Teresa, strongly believed that this could be the reason for their indifference towards her on return from holidays.

Since the day she returned from her holiday, Teresa’s life had become more unbearable. She was afraid that she would be dressed down in the presence of her staff. Her counterpart became hostile towards her. Teresa was unnecessarily kept back at work some days and, as a result, would miss the bus provided by the hospital to transfer nurses to and from work and have to risk her safety by taking a taxi to the compound. While taxis were the optimum mode of transport, it was not considered safe travelling in them at night, as not all drivers were trustworthy. At one point, the nurse manager pushed Teresa to go ahead and attend to the pharmacist who had just walked onto the ward. Teresa became convinced that she had swapped one set of workplace problems for another, as her emotions began to fall apart on the work front.

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All was not gloomy, however. The compound was not a prison, as it first had seemed. The security was high in order to protect those who lived inside. That reality sat much better with Teresa than her initial impression. The compound became a refuge from the rigidity of the outside world. Normal clothes were allowed to be worn inside the compound, regular gatherings were held to meet with fellow expats which provided a forum to communicate, share experiences, or have a whine. Daniel the young Irish expat in villa 39 was a natural when it came to organizing a social function, he was fun to be around and was always very hospitable to all the expats in the compound.

Many nationalities were represented: from the French to the Irish not forgetting the Aussies and a couple Americans. All residents were professionals or ran some kind of business.

The get-togethers proved to be a great outlet with some amazing, friendly gatherings that helped to release the stress of the workplace.

Teresa cooked her Indian food at some of these parties, which added a bit of zest to the gathering and gave her great feelings of being appreciated when all enjoyed her cooking. Homemade alcohol was served and helped to relax the atmosphere. She made it a point of always being in control. She usually had a good evening and was ready for bed by eleven. Slight normality entered her life as she sipped on a glass of wine and chatted to fellow expats. The Irish were particularly a hoot. They were extremely friendly, and knew how to have a good time. Villa 39 was an open house and the place to be if one was a bit lonely. She appreciated the lengths to which some of the others went to include her in activities, and she felt that cooking meals was the least she could do to show her gratitude.

The embassies also ran regular monthly parties, which were a total success. They were great opportunities to let one’s hair down, listen to current music, and dance. Teresa enjoyed the break from 122

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the rigid lifestyle of wearing abayas or burkas and took advantage of being around fellow Aussies.

All embassies were very understanding about the dilemma faced by their people. One of the highlights of her stay in Saudi, was obtaining entrance to the American embassy, through one of the Irish girls who was dating an American soldier. The landscaped gardens and swimming pool was extremely inviting and pleasant to see. It gave the foreigners the feeling of being at home. The splash of kiddies diving and the chat of parents in the background made it feel as normal as resting in a suburban pool yard in one of Sydney’s famous council swimming pools. However, Sydney’s pools could not compare with the glitz and glam of the embassy pool.

Later, after that pleasant afternoon, the group dined and sipped quality wine at a restaurant within the embassy. Teresa would remember that evening with fondness. She had enjoyed chatting with her dinner companions, fellow Aussie expats, and watching several people enjoying a swim in the lavish pool. For a moment, she felt as though she was in a five-star hotel and not at a foreign embassy in Saudi Arabia.

She was always lonely, missed Martin and her two younger children terribly. Despite the rewarding salary that allowed her to support herself and help cover some of the bills, the remuneration benefit could not compensate for the true friendships shed left behind in Australia or the family she knew and loved.

With great excitement, she made her way to the airport in the September of that year to meet her hubby and seventeen-year-old son. They were overwhelmed to see her dressed in an abaya, so very different from her Western dress. Tears welled up in Martin’s eyes as he gave her a big hug.

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Her son was not impressed to be in Saudi Arabia. At seventeen, he would rather see girls’ faces than have them covered up. He would much rather see a pretty girl’s face than a pair of eyes peering at him from the top of a dreary veil. He did not think it fair that, while they could see him, he was not able to see them. He enjoyed a day in the desert riding the quad bikes and going for a drive, but he was secretly glad when he boarded the plane to head back to Sydney and waved good-bye to his parents, two weeks later, Martin Senior stayed another three weeks, and after some good quality time with Teresa, he headed back to the land of freedom.

Teresa began to investigate the possibility of her husband joining her on a permanent basis and soon discovered that a slight technical error had occurred when she filled in forms for her visa, which proved to be a problem. Instead of writing she was a “charge nurse,” she wrote that she was an “RN.” The law stipulated that only charge nurses were permitted to have their partners stay with them permanently. Despite a letter from the director of the hospital, there seemed to be on going delay. Paperwork was lost, and the hassle continued. She seemed to spend all her breaks rationalising and pleading with Human Resource to speed up the paperwork so her husband could join her. It became a nightmare. Despite other people intervening—including her good friend, the Irish man Daniel who worked in HR—she felt as though she had taken two steps forward and three steps backward.

The workplace continued to be a challenge, and it became even harder when a clinical educator was hired. She joined forces with the manager and fellow charge nurse to isolate Teresa. The three executives went out of their way to make life difficult for Teresa.

At executive meetings, she would be excluded from planning and 124

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decision making, her opinion was never considered valuable, and once again, her self-esteem began to plummet.

During her second Christmas in the position, Teresa decided to meet Martin in Paris for her five days off and then return to Riyadh to have a few weeks together before he returned to Australia.

Martin was always allowed to visit after visa approval, but he never was given the sanction to stay permanently, as first promised.

Flights and accommodations were booked. Teresa was bursting with excitement to have a white Christmas in Paris, something she had never experienced before. Each exit from the country always required the filling in of forms and approval from the Director of Nursing and Director of the hospital. Most staff members who left the country (for just days off; not annual leave) submitted their forms a fortnight before departure to get them signed by the director of nursing. Without the slightest delay or hassle of deferred paperwork, she would sign it on several occasions, and they would be well on their way to their destination, to a country with a free lifestyle and within close proximity of Riyadh. Paris, Dubai and London were such countries. For annual leave, the paperwork needed to be signed six weeks in advance as most staff (expats) were going home for a few weeks and travelling quite a distance.

When Teresa presented herself to the director of nursing three weeks before departure, she took pen in hand and then glanced to see Teresa’s destination (Paris). Following the glance, she straightened herself in the chair and flatly refused to give her consent by not signing the form telling Teresa that she should have come six weeks earlier. Teresa’s heart sank. What would she do? She must go to Paris with Martin. She had been anticipating this moment from the time she paid for the flights and booked the accommodation. Martin was meeting her at Charles De Gaulle airport on December 23rd. She 125

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pleaded with the stern director, who became even more adamant that the forms should have been brought down to her office earlier.

When Teresa explained that the tickets and flights had already been purchased, the director turned away, her face a mask of indifference.

A despondent Teresa left the office.

Who would have the heart to take the experience of Paris from a person? Teresa knew she must do something. She had to board that plane on the twenty-second, she would be in Paris only four days.

She had looked forward to this for far too long to let her dream of travelling to Paris with Martin go up in smoke. Her time in Saudi Arabia had not been pleasant. Only treats like this trip to Paris, made the unpleasant experiences worthwhile. She walked aimlessly in the heat of the Arabic sun despite the fact that it was well past summer, the temperature was about 30 degrees centigrade. She told herself she must do something as she walked to HR, to the director of the hospital’s office, convinced she could now take this walk with her eyes closed.

As his signature was required on the form as well, she must see him and obtain his support. She decided she had one last chance.

His signature was to follow that of the director of nursing. He was busy on the phone, so Teresa told his secretary she would wait. The secretary saw the nervous sweat Teresa was in and, displaying a supportive attitude, ushered her into the director’s office as soon as he was free. Teresa put on her best manners and started with “Sir.” She then went on to explain her dilemma. The director was sympathetic to her cause and listened carefully. When she had finished, he said, “It does not matter to me when I sign the form, but I cannot sign it without your direct boss’s signature.”

Teresa pleaded and boldly said, “Sir, can you please call her and ask her to sign it then?”

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The director looked long and hard at Teresa, and the corner of his mouth turned up in a wry smile. He was beginning to understand how much this trip meant to Teresa.

He said, “Okay, you go and tell her that I approve of you going and I am prepared to sign the form.”

Teresa offered a hesitant thank you and walked back to the director of nursing’s office. In her heart, she hoped her efforts would meet with success. Her knock on the door received a brief “Come in,” but the director of nursing’s look hardened when she saw Teresa. A nervous Teresa explained what had happened and relayed the response she got from the director. A very annoyed director of nursing grabbed the form from Teresa, and in an instant, it was signed. She grumbled words to the effect that HR should not complain when forms came in late next time. Teresa looked anxiously at the form as she signed it, knowing full well that, when requesting days off (five or six in a row), nurses do not have trouble obtaining a signature of approval on the forms by the Director of Nursing. In fact, getting away for breaks was encouraged.

She felt the heaviest weight lifted off her shoulders as she wearily said, “Thank you” before she left the office and then whispered, “Thank you, God.” Teresa felt like this was the beginning of the end as she walked away. She felt she had aged ten years and she could not handle this stress anymore. She quickly dismissed those negative thoughts as she realised she would soon be on that plane to Paris. There was much to look forward to in the next two weeks. She would simply put down this latest bittersweet experience to character building.

As expected, the trip to Paris was a hit. The first meeting her husband after a six-month separation and now, the simple reality of being in Paris, made her want to squeal with joy! They made the 127

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trip to the hotel via train. It was surreal to be travelling and looking through the windows to see paddocks with snow-covered fences and snowflakes gently falling as the train sped along. It was even more exciting when her daughter called from Australia. Martin and Teresa could not contain their excitement. How beautiful was this experience.

Yes, the trip had been worth fighting for. Paris was all it was said to be and more. The time was short, but oh so sweet! The Moulin Rouge was a hit. The glamour of the dancers’ costumes and the truffle entrée with champagne topped off the perfect evening. The Louvre, with its inspiring works of the great artists, was magnificent, and she could not stop singing the song “Mona Lisa” after seeing da Vinci’s exquisite work of art. Just to be in the “city of light and love” was magical in itself. Four days in Paris was not enough. She must return to explore more of this romantic city and all the charm it had to offer.

When she returned to Riyadh with Martin, she felt she had gone from the sublime to the ridiculous. She asked herself what she was doing in this confining place. She did not like it. Her childhood asthma had started to flare up, the dollar was rising, and as a result, wages were falling. This was good for the Australian economy; however, it was not an advantage for the expat working abroad. She would really love to have Martin here on a permanent basis. She had exhausted almost every avenue of staying and achieving happiness.

However, her husband was here to stay for six weeks, so she must enjoy every moment of his time here.

Teresa also enjoyed friendships she had made within the compound. There was the Scottish/British family who lived across from her. Teresa would have some good chats with Elaine. She adored her children. They were so well mannered, and they liked Teresa 128

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as well. They would often share and sample each other’s food. The family particularly liked Indian food, so Teresa enjoyed making them the odd dish.

The girl next door, Jane, also became good friends with Teresa.

She was British and married to a Canadian. She was here on her own, but she had lived in Saudi Arabia with her family three years earlier and had experienced the bombing attack in 2003. Having lived in one of the compounds that were bombed, Jane’s family were among the very many who the tragedy had affected. The events that followed the night of the bombing had been horrific.

Teresa remembered a chill running down her spine when Jane described the traumatic night when their windows had been shattered and they’d heard screams and sounds of confusion as people were shot at or cried out in pain. Thankfully, they were unhurt but much traumatised. While other westerners were leaving in their droves, Jane and her family stayed four years after the bombing and then decided to gather their belongings and leave for their hometown showing a true sign of tenacity. The mass exit by the Westerners left a void within the hospitals and other employment areas which provided an opportunity for those who stayed behind to take on senior positions. A major change took place in nursing and around Riyadh at that time.

Jane and her family left in the hope of settling in California, but Jane soon realised she would be unable to get a job in the state of California because she was not an American citizen. As finances grew slim, she decided to return to Saudi three years later to earn more money. Like Teresa, she’d left her family behind. They had a lot in common. Jane’s two children were same age as Teresa’s two youngest.

They both had the same values, and had some great discussions about families and politics. The two women would exchange recipes, have 129

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coffee, and often take the bus that the compound provided to just look around or shop for groceries.

When Teresa left to visit Sydney, Jane would look after her cat, Visken. Visken had immediately taken to Jane, and the two soon became friends. Teresa knew her cat would be looked after well while she was away. In fact, almost always when she returned from holidays, Visken had put on some weight.

Teresa had sneaked Visken into her villa one day when the mama cat had strolled into her kitchen with her four kittens. She had been thinking of getting a kitten to cuddle and care for. She thought it would be a great way to nurture her maternal instinct and, to some extent resolve her loneliness.

The mama cat, with her four kittens, walked in to the villa a grumpy look on her face, she snooped around and strolled through the lounge while her kits playfully scampered about. Teresa began to guide them out of the villa when she suddenly realised this might be her opportunity to keep one. The kitten that was last to leave got to stay as Teresa’s new playmate. Teresa loved to come home after a hard day’s work to cuddle Visken. Soon they became good mates, except on the occasions when papers would be all over the place and the house looked like a two-year-old had been let loose.

Nevertheless, Visken was a delight to have around. She had the cute habit of running into the fridge each time the door was opened. On one occasion, Teresa was deep in thought and unaware that Visken had quietly sneaked into the fridge. The sound of muffled meows finally drew her attention to the problem. Visken was not allowed in the kitchen from then on. However, she was quick. She would run in jump on the breakfast bar and climb high onto the cupboards where Teresa could not reach her. She got a bit of a shock when Martin was there. His tall frame allowed him to reach Visken and remove her 130

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from her lofty kitchen perches. From then on, Visken would lie at the kitchen door and just watch the couple cook, she soon forgot the habit and took interest in other play around the house.

Visken had a unique personality. She was cheeky and loved knowing that she belonged somewhere. Teresa was sure she bragged to her stray cat friends in the compound. Periodically, the management made the cat round, and Teresa made sure that Visken was well and truly indoors during the cat catch. The cat numbers were out of control. It seemed the only way they were able to curb them was to periodically do a round and euthanise the cats. However, experts said that this only attracted more cats from other areas. Not sure of the reason for this belief, however, Teresa thought that to neuter the strays was a much better option than euthanising. Teresa was amazed to see that Visken’s mum had four separate litters in a period of ten months. Visken was very friendly and always took to her new carer.

She got used to Teresa going on her breaks and, at the end, would curl up on the couch and give a look as if to say, “You’re off again.”

Everybody relied heavily on their breaks and looked forward to heading home to visit family. Trips home would become the centre of conversations on the bus trip as time got close for people to take their breaks. The ritual of collecting one’s passport from management and flight ticket from the travel department meant that, in less than twenty-four hours, one would be on their way to travel.

Back in Australia, plans for the approaching wedding was going well. Teresa’s daughter Tina, the bride-to-be, was in control and proved to be very efficient. She knew just what she wanted and went about carrying out her plan in a systematic fashion. Being in Saudi was making Teresa a bit restless, particularly because not only that management was treating her unkindly, but she was so far away from all the discussions and chats for the wedding. She knew her 131

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spare time would be better spent at home in Sydney preparing for the special event. She was thankful that she would at least be present for the wedding.

At the hospital, being in charge was a great responsibility. Teresa loved taking the many young nurses under her wings and guiding them. She also liked creating a pleasant atmosphere during the work time. She strongly believed that productivity was at its highest when the atmosphere was relaxed. Teresa was not going to let history repeat itself. She would care for the nurses, ensure the environment was a happy one, be tolerant, and speak in a civilised manner to every staff member on her team. It felt like a great sense of achievement, when staff would come up and say to Teresa that they loved working with her.

Most of the nurses in the unit/ward highly regarded Teresa and appreciated her skills, but they were too scared to openly acknowledge this as they were in fear of being victimised themselves. Bullying was alive and well all over the world. Many of the nurses secretly approached Teresa to let her know how they felt. She appreciated that, but it was cold comfort when she was dealing with the confrontation and unfairness of management. In the wake of anxieties within the home in Australia, her daughter’s upcoming wedding, and the rising dollar, Teresa was compelled to come up with a plan.

During those days, when all three executives worked and staff meetings were scheduled, the air felt thick enough to cut with a knife. The tension was so severe that it became unbearable. Teresa began to think seriously about the future. She would be going to her daughter’s wedding in a couple months. Martin was now in Australia and preparing for the events of their daughter’s marriage.

Teresa also had several plans for that year. She would attend her daughter’s wedding in April, return to Saudi, have a break again in 132

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Scotland for a relative’s wedding, followed by a trip to Europe. On her return to Saudi after the wedding in Scotland, she would resign and close this chapter of her life. She did not get in much travel as originally planned, but she knew it was time to go home. With the end in sight, Teresa enthusiastically began to write a poem for her daughter’s wedding, a request Tina made of her. She started counting down the days until her departure for the wedding for which she had waited all year. It took precedence over Kate and William’s royal wedding. William, the son of Princess Diana, would marry Kate the day before Tina and Samuel’s wedding.

The days flew by, and before Teresa knew it, she was collecting her passport and picking up her airline ticket (paid by the hospital) from the travel department, a fringe benefit guaranteed to employees.

Her flight was to take off at midnight. She worked that day, and she was due to have her appraisal with her line manager. Her line manager, being vindictive as usual, took her sweet time, despite knowing that Teresa was catching a flight that night. She stayed back and worked the twelve hours that Teresa did and called her late that evening, delaying her even more and resulting in a late handover to the oncoming shift.

Teresa missed her bus that night and had to risk her safety by hiring a random taxi driver to take her home. She must complete packing, a quick clean of the house, and prepare for her cat sitter who would be staying at Teresa’s place. Teresa would never forget the stress she experienced that evening. Riyadh had a heavy downpour of rain, and all the roads were flooded. Because it rains rarely in the middle east, storm water drains are absent. As a result, a heavy rainfall results in flash flooding and long traffic delays. Teresa sat in the taxi and prayed she would get home on time. Thankfully, she did despite the holdup. In the blink of an eye, she was wheeling her 133

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suitcase to the front door and waving good-bye to Visken, who gave her the usual “You’re deserting me” look.

Nineteen hours later, she was in the comforting arms of her dear husband and seeing the friendly faces of her two younger children.

She asked herself what she was doing, living so far from home in an unfriendly environment when she could be here, surrounded by a loving family. There was much to discuss and learn, and she was so anxious to see the bride-to-be.

Her daughter arrived later that day, looking bright, bubbly, and slim as ever, complaining that she had to be careful as the weight was melting off her. Her dress must not be too big. Big hugs were exchanged as they huddled on the couch and discussed the up coming weeks.

With Teresa’s nursing experiences in Saudi temporarily behind her, she soon changed to her mum role, keen for her gorgeous daughter to be wed. Her poem was almost complete, and she was satisfied that it was coming along nicely.

The next couple weeks were almost a blur, and the hen’s night was a success. Pre-dinner drinks were followed by an Italian meal and dancing at a Sydney city club to complete the night. Martin was able to leave the bux (an Aussie term referring to a party for the husband-to-be) and join his girls at the club. Odd as it were, there are no rules when it comes to family love.

The wedding itself was held at a beachside suburb close to Sydney.

All guests needed to stay the night, as home was a fair distance away.

The resort offered a beach on one side and a golf course on the other.

The wedding day was beautiful weather wise, despite the downpour earlier in the morning and the day before. The wedding planner came up with a backup plan in case it rained, as the ceremony was outside, but it was thankfully not needed. (A lot of prayer went into that day.) Three siblings and a cousin were part of the bridal 134

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party. Teresa, reluctant to leave, the bridal party, of the excited young girls dressing, strawberries and sparkling wine; was forced to drag herself away to hastily head down town and have her hair styled.

She returned to see her three daughters dressed in bridesmaids’ dresses. They looked charming. The pride in a mother’s eyes as she gazes upon these life changing, moments, a memory to last forever.

Even Martin Junior looked handsome. The confident eighteen-yearold would serve as the master of ceremonies for the show. Teresa was a bit nervous for him, but she knew he could do it.

When her daughter was finally dressed and had donned her headpiece, Teresa was forced to brush back the tears. This will be one long emotional night, she told herself as the photographer was getting into some awkward positions to get great photo shots.

While watching her daughter dress for her wedding was emotional, Teresa was not prepared for the flood of emotions that would stream through when Tina walked down the aisle with her father. The tears flowed, and the emotion was intense. Her daughter looked stunning, and Martin Senior looked handsome and clearly emotional as he walked his girl down the aisle. The tradition of handing one’s daughter to the groom is so wonderfully symbolic that the gesture itself brought with it another flood of emotion.

Teresa and Martin, invited family guests to their luxury resort villa, offering pre celebration drinks and nibbles while formal photos were being taken, this move served as an excellent ice breaker for those guests who had not seen each other in a long while.

The celebrations began not long after formal photos were taken and the speeches were over. Teresa’s poem was very well received, and so were all the other accolades directed to the happy couple. Her son rose to the role of master of ceremonies and made his parents proud.

It was typical of him to throw in a couple random jokes that got solid 135

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laughs. He called for an intermission when his father fumbled with his hand written speech from his suit pocket, to which his father replied that he would deal with him later. He told his eighty-eightyear-old grandma, who hardly drank that he wanted to see her glass filled with wine all evening. The wedding was a grand celebration.

Music, food, and company combined to make it all one big success.

The next day was a big anti-climax. Everybody was exhausted and tired and reminisced about the wonderful evening. Most of the close wedding party stayed on-site, so brief, warm comments were exchanged about each one’s experience as they passed each other throughout the morning. It would not be long before Teresa would have to put all this behind her and head back to Saudi to complete her contract and plan. She apologised to her sister-in-law that she could not be present for her sixtieth birthday, and all good-byes were exchanged to the extended family.

The events of the next few days, would change Teresa’s plans altogether and, to some extent, give her regrets. The family woke up on May 3 to the news that Osama bin Laden had been killed in a night raid in Pakistan. The news was huge and a relief to the Western world. The media overflowed with editorials about the raid and the process by which the action took place. The family was glued to the television for updates, and they were in awe of the breaking news.

There was a general sense of unrest in the world of terrorism, and rumours began to float around. With ten days left to fly out, Saudi Arabia had become unsettled, as all of bin Laden’s family lived in that part of the world. In fact, they were among the wealthy families who were well respected in Saudi Arabia.

Teresa’s family began to raise concerns about her return and, as a result, planted some doubt in Teresa’s mind about returning to the Middle East. After a couple of days of labouring over the thought, 136

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she decided to call the Department of Foreign Affairs for advice.

Their response was that they could not advise her not to go back, but reminded her, that in the current circumstances, Saudi Arabia was considered an unsafe place in which to be. Teresa agonised over her next move in the days to follow. In the meantime, her asthma, which had occasionally troubled her in Saudi, began to surface, possibly anxiety related. Furthermore, Martin, who had just been through the business of his daughter’s wedding, began to experience a rise in his blood pressure despite his medication regime. Teresa felt like she was torn between the decision to return to a place that was now considered dangerous, where her charge nurse position waited for her, or to stay home and be safe with her family. She tossed and turned at night. There were all her belongings and dear Visken to consider. She would have to rely on people to step in and help. She just did not know what to do. Finally, after making a list of the risks and benefits at 1:00 am in the early hours one morning, five days before she was to fly out, she wrote a letter to her director of nursing and to the deputy director of nursing to inform them that she would not be returning to Saudi Arabia to continue in her position of charge nurse.

She had mixed feelings and relief but also regret that her “great adventure� had ended like this. She would miss the unique lifestyle to which she had adapted, the shopping, all the British clothing shops, the convenience of a bus to take her shopping, and the Saudis, for whom she had grown to develop for a fondness. On average, the Saudis, even though she did not embrace their religious practices and the ways in which they treated their women, were very family oriented. They loved learning English, and in their unusual way, they were likeable, though some of their ways were strange to a Westerner. The poor especially were found to be humble, caring, 137

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and simple. Their simplicity brought an agreeable quality with it. She investigated the possibility of bringing Visken to Australia, but soon learned it was not possible. Laura, the girl who was staying in her villa, unfortunately, bore the brunt of the news. And after the initial shock, she understood and committed to helping out.

A couple returning to Australia, Michael and Sally, had booked a container and offered to help bring Teresa’s belongings back home.

She paid a very small percentage of the cost. She had not accumulated much in Saudi Arabia, just a few souvenirs. The sorting out was kindly done by Laura, to whom Teresa would forever feel indebted.

Michael and Sally were returning to Australia also. They had become good friends with Teresa and were very consoling during difficult times. All three were charge nurses; therefore, they were often able to confide in each other and understood the pressures of the job.

Michael became good friends with Martin during his visit to Saudi Arabia. They had gone out for coffee or breakfast together and enjoyed lengthy chats. Sally was very maternal.

Teresa would never forget the picnic the two couples went on, along with their lovely daughter. While Teresa made her famous chapattis and scrambled eggs (Indian style), Sally had packed the perfect picnic basket: meats, breads, pickles, sauces, and soft drinks.

The spread was so neatly packed and laid out so well that Teresa wished she would always be able to think of everything that Sally had done to make picnics so perfect and special.

The day was fun with lots of chats and laughs. Of course, few picnics pass without a tale to tell. After finding the perfect spot to spread all the goodies, blanket included, on a perfect green lawn with added shade (not easy to find in Saudi Arabia), there was a click and a gigantic force of water. The sprinklers had come on, and soon the picnic lovers were almost saturated. With screams and giggles, 138

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all five were quickly dispersed in different directions. The sudden shower was a surprise but a welcome relief to the Arabian heat, and the day ended with a warm (or rather cool) memory.

Sally’s and Michael’s home in Saudi was like a museum of Arabian antiques. Each time someone visited, there was always something new to look at. With each item came history, which Michael was excellent at explaining. The couple seemed to have the perfect skill for selecting unique souvenirs, which not only fascinated Teresa and her husband but quite a few of the expats who visited them. It was no wonder that, on their return to Australia, they needed a container.

Teresa was relieved when Michael informed her that they could help with bringing her important collections and belongings back to Australia. Michael and Sally helped as well to organise her gear.

Three months after their arrival, the container with Teresa’s belongings sailed in. Teresa hoped to, one day get together with the Aussie expats from 2009. They would reminisce, drink quality wine, and just enjoy each other’s company. However, life changes so much on return to one’s homeland that the get-together remains a goal for the future.

Unfortunately, Visken was taken to an animal shelter run by a French vet. Teresa did not investigate to learn the circumstances of her fate.

So Teresa’s life in Saudi Arabia had come to an abrupt end. She did not attend the wedding in Scotland or go to Europe as planned.

Instead, she would once again need to look at options of employment in Australia. What changes in her professional life would occur?

Would any place provide a safe and secure environment for her, or would she have to face bullying and more mistreatment, perhaps even worse than she had experienced in the past? The question gnawed at her, causing her once again to doubt the decisions she had made.

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CHAPTER SEVEN

The Victims

This chapter, constitutes journal entries, reports, letters and thoughts, written by Teresa during a series of events that took place in the course of her nursing practice, an ordeal that challenged her mental and emotional stability on both personal and professional levels. This chapter is dedicated to those she has known or worked with and have fallen victim to bullying in the workplace. Some have provided written accounts of their experiences, and others have expressed their thoughts through verbal narratives.

6 January 2007

7.1 Staff Meeting, Unexpected Guest On the pretence of discussing the grading of the clinical nurse specialist (CNS), Educator Jean came to the staff meeting. The educator has not attended the meeting before, and CNS grading has never given cause for an educator to explain the proceedings since the process is very straight forward as any clarification of protocols has always been addressed by the manager. Furthermore, because the nurses were all CNS’s and have been with the hospital for a 141

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while they were all well aware of the grading system. I’m convinced that there was an ulterior motive behind Educator Jean’s presence.

She attended the meeting specifically to watch me closely and to monitor my interactions. I was extremely anxious and nervous, and I know the others were also aware of the real reason behind Educator Jean’s presence at the meeting. Not only did this situation cause me immense embarrassment and anxiety, I could not fathom how my interactions at a staff meeting would provide information about my work performance. I made an attempt to participate and to not be self-conscious. My heart pounded throughout the meeting, and I felt like I was, being watched by all staff members, and they were pointing their fingers at me in a mocking fashion. Felt like the case of the classroom scenario of standing in the front for talking in class.

Educator Jean discussed the grading of the CNS. This discussion was followed by the topic of educating the patient who is “not for resuscitation’” (NFR). The point was made that the nurses should not educate NFR patients since that policy is part of the protocol for the chronic disease program. The passion I felt about educating the dying forced me to start a debate against the protocol. I argued that it should be allowed so these patients can go home to improve their final days with a reasonable quality of life. I pointed out that it is a moral obligation to educate these patients instead of allowing them to go home and drown in their own fluids. I got opposition and a sharp glare from Educator Jean. At the end of the meeting, Manager Viola, TL Agnes, and Educator Jean stayed behind and talked. I suspected they were discussing me.

Well, I certainly performed for them. I feel strongly about educating NFR patients, and I was criticised for doing so. I’m sure the agenda item of educating NFR patients was a setup to get my defences up. I know without doubt that I will be in for some mean treatment when TL Agnes and Educator Jean make their visit to see me at work in two weeks’ time.

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# 26 February 2007

7.2 Meeting with Agnes (team leader) and Jean (educator) Agnes and Jean came to question me about my work. The size and stature of these women intimidated me. I was nervous. I wished I did not have to deal with the situation. I got all the necessary files together for them and just gave them what they wanted.

They walked into the office at 8:30 a.m. My stomach churned when I observed their looks of contempt and unfriendliness. I fumbled for words. Educator Jean made an effort to be civil, but TL Agnes did not. Instead, she challenged me with the accusation that I educated a patient who had come from a nursing home and should not have been educated. She reiterated that she would have refrained from doing so. I clarified that in some instances one has to be self-directed and manipulate situations to suit a need. The fact remained that the patient, despite coming from a nursing home was a capable, lucid, seventy-three-year-old who would benefit from education; he would be able to comprehend the concept of managing his chronic disease and as a result achieve the desired outcome of reduced admissions.

TL Agnes did not accept that. Glances were constantly exchanged between Agnes and Jean. The two women continued to question me.

They asked why forms had not been completed and why paperwork was not up-to-date. I knew they were aware that I’ve been unable to perform administrative duties as effectively as I might have done due to the time factor. I explained that I often entered information straight into the computer instead of documenting twice. At one stage, Educator Jean gave me the abrupt order, “go and photocopy 143

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this.” Feeling like a five-year-old, I obeyed. I returned, knowing fully well there was no need for the photocopying. The request was no more than an opportunity for them to snoop around. They stayed an hour and a half and departed after a cold “See you later.” I was relieved when they left, but a sense of anxiety overcame me as I tried in vain to resume my duties. # 6 March 2007

7.3 Meeting with Viola (Manager) Human Resource Manager Mr Nelmes and Jean (educator) While at work, I received a very friendly phone call from my manager, who stated that she just wanted to have a chat. Not a big deal, was her candid comment. She requested, I go to the main hospital. Around midday, to what, I was led to believe a friendly discussion, turned out otherwise I should have known. When I arrived, a Human Resource representative, Educator Jean, and Manager Viola confronted me.

Their attitudes were condescending and hostile, and they told me that the reason for the meeting was to inform me that I have to undergo a clinical assessment. I needed to complete a physical assessment on a patient and be observed by Educator Jean, it would be carried out at the main hospital away from my comfort zone and I needed to nominate a suitable day for this to be carried out.

I was caught off guard and unable to comprehend the reason for this new demand. I needed a support person, but I was not given sufficient time to arrange for one. None of my colleagues had been subjected to this type of random assessment. Furthermore, it was not 144

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my clinical skills that were in question, but my data entry skills. I felt let down. Difficult to understand, I concluded they were grinding me to an emotional halt, and I was unable to do anything about it. I strongly believe that their intention was to humiliate me.

After the meeting, the nausea struck, as I ran to the bathroom and threw up. I wished I had never shown up for the meeting in the first place, at least not without insisting that a support person be present. The requirement, took me completely by surprise. Knowing I had nothing to be concerned about when it came to my clinical skills, I reluctantly agreed to the assessment. It was not until I arrived home that I became annoyed and realised how unfairly I had been treated by being subjected, to this unnecessary assessment, I decided to dig my heels in, and do some research before I relented.

Later, I enquired off another colleague about the assessment and its need. Perplexed, the colleague questioned TL Agnes, whose response was, “That is only for Teresa and not for the rest of you.”

A later discussion with my union representative, Renata, confirmed my feelings that I should not have to be subjected to an assessment if it were not part of my peers’ requirements as well. I suspected that Renata had spoken to Manager Viola and Educator Jean. My manager did not raise the issue of an assessment again. # 7 August 2007

7.4 Disciplinary Action Without warning, a letter of disciplinary action arrived in the mail.

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Counselling and Disciplinary Action Dear Ms. Jones, As advised by Mr. Nelmes, the HR manager, you will be required to relocate to the main hospital (name withheld) site so that further training and supervision can be administered to improve the work performance issues. At this meeting, you will be provided with a comprehensive plan regarding what will be required and what assistance will be available during the relocation period. A time frame and open discussion regarding the details of your relocation will be discussed thoroughly with you at this time. You will work with the TL Agnes and myself. Please confirm attendance at this meeting upon receipt of this letter.

Regards, Ms Viola Smith (Manager) After recovering from shock over the disciplinary letter, I took the matter to Renata, my union representative, who questioned HR. The department agreed that the letter was not warranted, and it was withdrawn. The tone of all work-related letters I received was one of humiliation and condescension.

Meetings had become a nightmare to attend. It would be in my best interest to have a support person present each time I was requested to attend a meeting. When on my own, I’d been subjected to major attacks from the TL, the educator, and my manager. #

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13 August 2007

7.5 Email

One email came by accident to me when I expressed a reluctance to attend meetings because of the short notice and the stress it was starting to cause me.

Dear Viola, What can you do, Viola?! Looks like she is getting all rattled.

Agnes As mentioned earlier, the constant meetings at the main hospital, which was an hour and a half from my workplace, was putting me further behind with my paperwork. The pattern of frequent meetings, driving the long distance to the major hospital and recovery from the meetings had been happening for fourteen of the twenty-four months I had been on the job. The reality was that I was becoming less productive in the workplace and more anxious at home.

7.6 Solicitor’s letter to Viola Nurse Manager Following the stressful meeting, from which I subsequently drove through a red light and was unable to recall the trip home; I decided with my husband’s counsel, to see a solicitor. The solicitor wrote the following letter to my manager.

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17 September 2007 Dear Miss Smith, Please be advised that I act for Teresa in relation to legal issues arising from her employment with her area health service (AHS). I have been instructed to write a letter to you in response to a sequence of events dating back to at least 2006 and which relates to alleged performance concerns regarding my client, who is employed as a CNS grade 3 with the Public a chronic disease program at the small beachside hospital, as well as assisting in a rehab program at another hospital.

Up until 2005, my client and her colleagues were supported with the assistance of a data entry clerk. Since that time, my client has had to perform a significant amount of repetitive data entry work, a duty routinely performed by administrative staff, whose employment is regulated by a separate award.

In December 2006, my client was directed to a meeting with management to discuss some issues, one of which pertained to data entry details. My client gave a detailed response on December 3. The meeting did not lead to disciplinary action or to the identification of any alleged performance concerns.

In February 2007, my client was met by the educator and the team leader (TL), for the purpose of monitoring and assessing her performance. to a meeting at the main hospital and was verbally 148

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informed as to what alleged deficiencies were noted during the assessment in February 2007. My client the alleged deficiencies.

Please note, however, that my client wrote to you that you failed to answer that letter.

On 21 May 2007, my client was subjected to yet another assessment, this one performed by the educator and the HR manager. Although the assessment was carried out on the date specified here, a written description of the outcome was not furnished until a more recent meeting of 4 September 2007, which was some three and half months after the event.

On 8 August 2007, my client was surprised to receive an email from you advising of a meeting to discuss relocation to the major hospital. The email attached a letter that was dated 7 August and On 4 September 2007, my client met with the educator and yourself, who read aloud a report dated 21 May 2007. However, the issue of being required to with at that time. My client was told to prepare an action plan, which she subsequently did and emailed to you on 10 September 2007.

A meeting was arranged on 11 September 2007 for the purpose of developing an action plan by consensus; however, the information supplied by my client, which was a comprehensive action plan 149

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supported by statistical analysis and workload, was totally rejected by you and the educator.

On 12 September 2007, the HR manager emailed my client to advise her that the disciplinary letter, dated 7 August 2007, had been withdrawn.

It is my view that this action was appropriate, as the AHS had categorically failed to follow the terms of the counselling and disciplinary policy, and that in any event, in light of the lack of procedural fairness, there are no substantive grounds upon which to move against my client with a disciplinary process. letter to my client affirmed the intention of the AHS to relocate her to the main hospital for training and about this issue, she was informed that the nature of the training would constitute data entry work under supervision and it would be the very same data entry she is already performing at the beachside hospital.

My client also makes the point that relocating to the main hospital to do this is completely unnecessary because her data entry work is already capable of being supervised and checked through the common computer network by her TL. months would be needed to perform these duties.

I wish to make it abundantly clear to the AHS that I consider the AHS has no legal right to direct my client to attend training at another work location for an indeterminate period of time, particularly in 150

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circumstances where there is no merit or benefit in the proposition.

It is patently obvious, even to a layperson, upon reading the minutes of the assessment day, 21 May clinical nurse in her particular field of specialty, which is cardiology. As best I can ascertain, the AHS is seeking to have my client do remedial training at the

that my client demonstrated the capacity to work autonomously on the day of the assessment (21 May 2007).

Unfortunately, this leads one to conclude that management has sinister and ulterior motives for seeking to have my client work at the main hospital. It is noted that there have been past episodes of personal conflict between my client and the TL. Those issues remain unresolved, and that is something that has recently been identified by management, who has suggested that our client undergo counselling to resolve those differences with the TL. However, should my client be relocated to the main hospital, she would be working in close personal contact with the person with whom she had that previous conflict.

As noted, it is my firm position that the AHS lacks a lawful basis for directing my client to undergo a period of menial training under micro-supervision for an indeterminate period of time. I have noted that the 151

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presumably, considering the circumstances, the AHS has been forced to concede that this is not a disciplinary matter and it lacks the legal capacity to a disciplinary process.

If you do consider that the AHS has a lawful basis for directing my client to attend the main hospital for unnecessary training, please specify with particularity what the legal basis is for this direction, including particular references to any contract, award, policy, or statute. Indeed, it is my position that the direction constitutes a breach by the AHS of its implied duty to refrain from acting in a manner that is destructive to the trust and confidence in the employment relationship. Instructions from management to my client have, at no time, provided her with any reasons for this relocation to the main hospital.

It is my position that the AHS ought to now unambiguously and unequivocally indicate in writing that my client will not be directed to undergo this training at the main hospital.

Please provide your response to this request within to this office. In the absence of a satisfactory written response from you, my client will not regard herself as having to comply with any proposed direction aimed at transferring her to the main hospital for training purposes.

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I also wish to put you on notice that, should the AHS seek to direct my client to attend the main hospital for the indicated training, she reserves her right to terminate the contract and claim damages against the AHS. I trust that this will not be necessary.

Yours faithfully, Solicitor # 10 August 2007

7.7 Inability to attend meeting Dear Manager Viola, Please note that I am unable to confirm my attendance at the meeting, as I have been unable to get in contact with my support person. The timing of the meeting has made it difficult for me to access a support network. Being denied the opportunity to arrange for support is unfair. For most meetings I have attended in the past, I have been given at least

four days, two of which I am scheduled to work at my other job. I would also like to point out, just for the record, that I have not been given minutes of any meetings we have had. Last, your phone call yesterday

You will attend the meeting!! You will have to treat 153

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a fear of attending the meeting on my own. I will have to wait now for a reply from my support person before I can confirm my attendance. Thank you.

Regards, Teresa #

7.8 Report to manager in response to accusations (excerpts) I am strongly of the view that an independent assessment of the facts will show that I have been diligent in terms of the number of patients I have screened. I have returned to work refreshed and in good health. I am keen to resolve the concerns raised in your letter and enclose an overview of my understanding and involvement in the program. After subtracting allocated days off, staff meetings, and public holidays, I effectively work 1.5 days per week. The introduction of the new database in July 2005 had the involvement of the TL to enter data pre-2004 and assist. This proved to be beneficial but produced conflict and an atmosphere that was clearly strained. Basically, I was refused to allow another colleague to assist.

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Time Management As stated, I effectively work 1.5 days per week. I see as many patients as my colleagues see on other sites.

I currently screen fourteen to twenty-four patients per month. Up until July, I was averaging two home visits per month, which is the same number as my counterpart, who works three days per week.

Maintain Database Site to an Acceptable Standard Computer has been unreliable. Database is not always accessible. There are difficulties accessing and requisitioning files within a limited amount of time. Due to a high workload and stress, I have missed some entries. Comment. Abusive phone calls, emails, and physical confrontation have taken their toll and have resulted in selective communication.

There is a definitive pattern of behaviour towards me, which is downgrading and noticeably absent in the behaviour towards my colleagues. Phrases like,

relationship more than building a bridge and has caused enormous stress. I do not know any colleague who is spoken to in this manner. I have been prepared

A volunteer, upon overhearing a phone conversation

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your attention in July 2007, as it breaches the Code of Conduct.)

Conclusion Five months ago, my colleague and I were promised computers. My colleague received one despite the three-week down time in July. My request, however, was ignored, and I never heard anything more until I emailed recently, three months after my colleague had received a computer. I believe it should have been clear that, in working only 1.5 days a week, it was of utmost importance that I obtain access to a good, functional

on-site from the start, and consideration should have been given to the time spent in travel to meetings.

Productivity has been affected due to these issues. I have implemented changes to my practice, which, with time, I am confident will rectify the problem. Support, mutual respect, and sharing resources will also assist in resolving the matter. Thank you for your time. I look forward to your reply.

Teresa #

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17 October 2007

7.9 Formal complaint To: Senior Nurse Manager of Medicine Subject: A Formal Complaint of Bullying/ Intimidation and Discriminatory Behaviour PRIVATE AND CONFIDENTIAL Dear Ms. Senior Manager, I am writing to register a formal complaint against my manager and TL regarding the circumstances surrounding my employment as a chronic disease nurse, clinical nurse specialist (CNS) at the beachside hospital. I would like to draw to your attention to the fact that I have not been afforded procedural fairness, and the failure to follow established hospital procedure has resulted in me becoming the recipient of repeated, intimidating, and bullying practices. The following events have occurred over the last twenty months.

Background Twenty months after my appointment, I received a reliable computer to access and update the database. years for my manager to provide me with a working environment that could be regarded as adequate.

Since the initial incident of 13 June 2006, when the TL turned up unannounced, I have been 157

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belittled through rude emails and phone calls. The discriminatory behaviour towards me has added another dimension to the feeling of inadequacy. This pattern of events would occur even while I was at my other workplace, which made it difficult to perform warranted me to have a day off. The manager stated she would not approve family leave again with such short notice. My manager brought the educator onto the scene in January 2007. I found the manners of both As a result, I could not concentrate on appropriately answering questions. The issue shifted from data entry to clinical competence, and the manager and educator stated I would have to succumb to a physical assessment, which was to be performed at the main hospital and out of my comfort zone. In spite of the findings that I could work autonomously, I was informed that I was to be relocated to the main hospital, where, during the process of performing my data entry, I would be supervised by the TL, the educator, and the manager. This work performance can be adequately and more efficiently managed from the beachside hospital. Another issue is a breach of confidentiality with patient files leaving the premises and patient addresses, phone numbers, and medical histories being transported to another location. I spent most of the weekend creating an action plan as requested and handed it in prior to the meeting. It was totally dismissed, and I was told that one would 158

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be developed for me. With the tacit approval of my manager, the TL has been able to change the status of patient enrolments without consult and without communicating patient details (e.g., admissions). TL Agnes then proceeded to question me about entering the information into the database. Furthermore, she that the data will be collected and entered by myself and, of course, would appear that the TL has done the hard work. Other disturbing incidents include removal of emails from a folder in my office and the deletion of certain patient information that I had entered into the database. All my decisions were carefully considered and in compliance with education was never offered to me in the first two years of my employment. In my opinion, the TL has always treated me with contempt. My manager and the TL have talked down to me on several occasions in the presence of my colleagues. When the TL has scheduled My assistance and help on education days has gone thankful email has been sent to other colleagues when they have participated. A poem I wrote on heart failure was refused inclusion in the newsletter. This poem was accepted into the International Society of Poets and of this year (2008). I received a reward last week, in the mail, for my efforts. I stand by my assessment 159

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that each patient was carefully and correctly enrolled in accordance with the chronic disease criteria. The information that I have provided confirms my clinical competency and is further evidence of the intimidation and abusive behaviour I have received. I believe that, based on a fair assessment of my screening of patients, there is clearly no need to relocate me to another hospital for further training, which would only serve to increase the stress to which I am already subjected.

I look forward to the matter being investigated and resolved in a fair and reasonable manner. I thank you Yours sincerely, Teresa Note: Following the several meetings, close accidents, nausea, and sleepless nights, I decided that only correspondence would work and serve to maintain my sanity; hence, I decided that emails would be the best way of communication, as meetings were placing an enormous pressure on me. #

7.10 Final Letters Among the final letters, here’s an excerpt from one senior manager to me.

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Dear Ms. Jones, be the best way to communicate due to the tone of attendance at these meetings is a reasonable one.

Future communication with you will not be through written correspondence. I am now providing you with a one-month notice of your relocation. This relocation will take place beginning Tuesday, 27 November 2007. An office will be made available for you at the main hospital. During this one-month period, you are required to hand over to (name withheld).

Commencing 27 November 2007, (name withheld) will take over the office at the beachside hospital.

This was a gut-wrenching letter. I refused to attend further meetings or to go along to the major hospital. I was given two weeks to decide. In the meantime, the kind director of nursing from the small beachside hospital, who observed and recognised the quality of my work found me a position in medication safety, an area in health care that needed much attention. Hence, the situation was on pause temporarily while I moved into a different role. My biggest relief was that I would not be required to attend further meetings as I was performing different duties. The position was eye-opening and took the focus off my own troubles. The chronic disease program paid my wages, and I knew it would not last.

Two months later, I received a letter in the mail and an email to state that my wages would be ceased. I had no alternative but to resign. I fought a good fight. One would find it extremely hard to win against a system, and this time, the battle was lost.

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7.11 Investigation: subsequent report on bullying Around the same time, the AHS (to their credit) had set up a joint task force to investigate several incidents with the main hospital, particularly those that had occurred in the emergency department.

Among the incidents investigated were the 2007 reports of bullying and harassment. I made an appointment and briefly told my story.

The two people on the panel stated that they were inundated with reports across the area and they were finding it difficult to handle the huge numbers.

The report, handed down sometime in 2008, resulted in the following recommendations:-Meppem and Dalton (2007), two retired health workers who were part of a task force, handed down the following report after several interviews with nurses.

1. It is advised that each nurse be given a fair and reasonable workload.

2. It is a matter of urgency and priority to ensure that the recommended review of bullying and harassment be fully investigated and that appropriate changes be implemented.

Managers received training, a cross Discipline taskforce. A crossdiscipline taskforce was established, and HR staffing was temporarily enhanced to manage outstanding allegations. According to the AHS, staff members have returned to their substantive positions.

Employment assistance programs were advertised. The report was handed down well after I was dismissed; therefore, I was not able to benefit from the recommendations.

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7.12 Verbal accounts of bullying As I went around trying to put the pieces of my life together and to decide which would be the best path to take, I met some remarkable people. I also found that I could now be open about nursing’s dirty little secret, and I was not ashamed to say that I had been a victim of bullying in the workplace.

Other reports I received, either verbally or by email, follow. One person shared stories about how she worked in a prison. The nursing agencies were not able to fill positions at the jail. Nurses would walk in and out the same day because, she stated, “the nurses’ behaviours were tougher and more callous than the prisoners themselves,” prisoners who were in confinement for hard and heartless crimes.

That particular prison, according to the nurse, had the highest incidence of bullying and intimidation. She could not believe how intense the bullying incidents were. She refused to be intimidated by them, so she lasted longer than most of the others. Nevertheless, she was glad when she obtained another position.

Another person I met while on contract in a remote placement reported that her friend had suffered horrendously by nurses with whom she worked. Sleepless nights, trips to the doctors, and irritability had become part of her recent life, she had changed from being a happy-go-lucky person to one who appeared worried and uptight most of the time.

Some nurses discussed bullying from physicians and allied health workers as well. This type of bullying did happen a lot in the 1970s and 1980s, and it probably happens a bit even now; however, I had not come across it as much or as often as I had seen nurse-onnurse bullying. I believe that, as with health workers, all doctors will 163

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defend each other. The same is not the case with nurses as a rule. A nurse in distress will generally be left out on a limb.

When she made one of her many trips to ER for her chronic asthma, one patient complained of receiving hostile treatment from a nurse and a technician. The patient was told by the nurse that, if she would just sit up straight, she wouldn’t have any trouble breathing.

One (anonymous) person wrote in the New York Times (2006).

nursing profession as much as it is a portrayal of how women in the workplace tend to treat each other. We are backstabbing, viciously competitive, and green with envy when it comes to our gender. Instead of celebrating our successes in the workforce, we sabotage and alienate those who strive to accomplish great things in their careers. The idea of nurses as nurturing a nurse practitioner for over 20 years. #

7.13 Written accounts of bullying I met Gail following my return from the Middle East, on one of my contract placements in the Northern Territory. Initially, we seemed to work opposite shifts; however, it was not long before we caught up for a brief conversation. Our friendship grew over the next few weeks, and one day, we decided to take the conversation to a less formal venue with lunch at a “quirky” restaurant, quirky as all the 164

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waiters were dressed like hippies, and large lounge chairs occupied one corner. Wooden chairs and tables were placed outdoors as well as inside the restaurant. The meals were mainly organic, the unique cakes with a blend of pumpkin and grains added flair to the menu and the varied customers created an interesting ambiance, The atmosphere was great, and the place was well patronised.

I soon discovered that Gail had been through a lot before she entered the field of nursing. She was humble at heart and worked extremely hard, and her aim was to travel. I learnt that Gail had also been a victim of bullying. When I advised Gail that I wanted to access her thoughts and experiences for inclusion in a section of a book I was writing, the resulting email reflected an anger that was hard to miss. This is what she wrote.

Hey, Miss Teresa, Nice to hear from you! How are you keeping? I remain in Melbourne working in ICU and look forward to my trip to Africa later on this year. I would be only too glad to provide you for asking.

I have come across many bitches in nursing, but the one that had the most impact on me was a manager I worked with in 2005, less than a year after my partner passed away. At the time, I was in my grad year at the public hospital. We had rotations through four areas, one of them being the surgical ward. There was a manager who did not treat me fairly; she did not like me and went out of her way to critical care course a couple of years later and had to 165

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hand over a patient to her one day, she did not have the decency to listen to me; she just kept talking to the nurse beside her. I went back to the coronary care listen to my handover and will probably phone to get bitch did! She has since left the hospital but got away with everything. I nearly left nursing because of that creature. The nurses on that ward did not show you how to do anything; they were just a pack of wolves.

It would have annoyed her that I did the critical care course. She was a mongrel for sure. It was because of how the bitch got to me. Everyone on the ward crawled after her, probably afraid of her lest they get bullied as well. That hospital has a reputation for not handling bullies; in fact, they practically get rewarded for their bad behaviour. # Taken from the journal article, “Bullying and Nursing� (Haseluhuhn 2005): A nurse was bullied to the point that she suffered from depression. The bullying stopped her from leaving her home and prevented her from filing a legitimate even forced to do personal work, such as sewing. She 166

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related field.

One of the managers belittled his employees in front of others and took credit for the work that everyone else did. He repeatedly trapped one woman in his office for the purpose of screaming at her. and her stomach in knots. At that time, however, she had no choice. she had to go to work. She did not want to face her boss; he made her life miserable. She approached the people whom she thought would be able to help her and told them of her dilemma. They did nothing.

Eventually, she quit. After five years, the woman still cannot bring herself to visit the town where she had worked and been bullied.

Veronica’s Recollections (2013) I have known Veronica almost most of my life. We hung out socially, we went into nursing at the same time, and we frequently discussed our profession, along with its amazing experiences and challenges. More recently, the point of conversation has turned to the adversity we face in the workplace. The following excerpt is a recall of events that made Veronica’s life miserable. A single mum with three grandchildren, she continues to struggle through the constraints placed on her in the workplace.

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authority. I find I have to be on guard at all times. with female managers and, in particular, nurse unit managers (NUMs). Derogatory comments, bossy attitudes, humiliation, and belittling tactics would frequently be thrown my way. They would show little to nil respect, and as a result, after a long period of abuse, I succumbed to that dreaded condition known NUM, someone with whom I had worked for ten years. Her derogative manner and foul language left me numb on some days. She openly showed favouritism and got away with it.

Her unlawful use of power restricted my ability to perform my duties as a nurse. She worked hard on bringing my self-esteem to rock bottom. Whenever she talked, she either used hostility or barked at me. on because I loved my job. It was challenging and stimulating. While working in a Monday-to-Friday twenty-four-hour care ward, I took the opportunity to choose a night to get away from the watchful eye of my bully manager. I could describe several incidences of her use of unauthorised power and harmful intimidation towards me as a person. One in particular stands out in my mind. The incident, which occurred on one of 168

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my night shifts, left me feeling as though I had been bullied. A nurse failed to commence an intravenous (IV) medication as required (despite being checked and signed by two nurses) before she completed her shift. The nurse in question was a favourite of the 80 per cent of the patients having IV lines and drains), and most patients on the ward were immediately post-operation. As a result, I was not aware of the issue until well into the shift. Seeing the problem when I did, I rectified it straightaway. I reported the home. She went into hysterics at hearing that the me, although a bit later than it should have been.)

The NUM failed to see where the problem had truly started and instead put all the blame on me, telling all the other staff that I had neglected to administer the drug. The nurse wrote an incident report on me.

The two nurses were not even spoken to, nor did they know how she would have justified the error without implicating the other nurses. I arranged a meeting with the NUM, the acting ADON, and the union delegate. The pressure was really getting to me at the time. I was reprimanded and received a warning for my practice. I felt the other two nurses should have been questioned as well. I felt like pursuing the matter energy. With working regular nights, I felt it was in 169

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my best interest to leave it as it was. I took the blame for the incident, but felt very hurt and demoralised.

The deteriorating state of my emotional health held me back. As mentioned, the nurse responsible for the incident was a favourite. Several incidents of malpractice by her had gone unnoticed or completely ignored. Despite the fact that the NUM was aware of the incidents, she would find ways to cover up for her. Immature people can act like little kids, so when they see weak links they try in every way to manipulate the system. At one stage, I had a problem with my knees (arthritis). The NUM screamed at me across the ward in the presence of all the staff when I gave able to cope with this work; you will have to find work area, I was treated like an idiot who did not know my job. I was always the one at fault when things went wrong. The TL and in-charge roles were given to me. I was never given the opportunity to improve my professional skills. Even the responsibility of mentoring students was given to others. Other staff members those roles. However, the treatment gave me reason to question her value of me as an employee. What came out of this affected my confidence and self-esteem.

Even more important than not being a very healthy environment to work in, it affected my family life, especially since I was bringing up my only child. I was 170

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told by a few confidantes to find another position, but being a single parent, the hours and type of work suited me; hence, I stuck it out. I strongly believed this treatment was undeserved. I always tried to be to the unit. I am a firm believer in teamwork and always practiced as part of a team. It was obvious character, whatever the reasons may be.

Thankfully, I persevered and am at a better place now. I may change my workplace at a more convenient time. I like my job and the variety it offers.

that taught me how to treat people as individuals

a person. So, you see, good can come out of evil.

Brenda’s Recollections (2013) I met Brenda in Saudi Arabia. I got to know her a little better at an afternoon tea, at other social gatherings, during shopping sprees, and the odd occasion at work. I soon discovered that Brenda was pursuing a career in law. Inspired by her change in profession, I often wondered what influenced the move. Brenda, a very wise lady, decided she was not happy in Saudi Arabia and resigned within three months of being there. When I approached Brenda about her thoughts on nursing and what swayed her towards a career change, her response was the following.

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I have been nursing for about twenty years, and in that time, I have met some amazing people, both staff and patients. I have worked in small rural hospitals, indigenous communities, and major metro hospitals.

I have worked as a staff nurse, a clinical nurse, and facilitator for universities and research. I have worked in emergency departments, wards, theatre, recovery, HDU/CCU/ICU, rehab, and community health. I have worked in Australia (Queensland and Victoria), England, Scotland, Isle of Man, Tanzania, and Saudi Arabia. Unfortunately, there are many negatives that stay with me. I can remember my first job in a small rural hospital, where the nurse in charge introduced me at handover and said to the staff that, as I had been trained at university, they would all need to be

until staff and patients started complaining to me about university-trained nurses. They thought that, as I had been nursing for a while, I must be hospitaltrained. I was always amazed at university-trained nurses copping crap for a system that was brought in by the previous generations of hospital-trained nurses. how we were trained. I have learnt how important it is to have a good and fair manager. In my time of nursing, I think I have come across two who were good 172

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to work for and ran a good unit. I have worked for so many poor managers who allowed and perpetuated unprofessional, bullying, and unsupportive work environments or managers who were killing time in places, waiting for retirement or were just there for the money or because they had been there the longest.

These people are in such important positions, and they are causing so much damage. Unfortunately, my last nursing position had possibly one of the most detrimental unit managers I have ever worked for, and it was in an environment where there was so much potential to make so many positive changes. I left nursing last year for a completely different career in law. I am surprised and disappointed at how little I miss a career that really did give me a lot of good as

Brenda, who has not long completed her degree in law and only started working in the area over the past twelve months, is finding the field extremely challenging and busy to be in. It appears that Brenda is very pleased with her change in profession.

7.14 Conclusion In the wake of reports, experiences and challenges there is a need to emphasise a point of paramount importance in the face of adversity with bullying, that is start a documentation process.

As soon as possible obtain a folder, and begin, jotting down dates, times, comments, collect emails (hard copies) and if possible record 173

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meetings. This process and evidence will support you in a court of law, particularly if you decide to stay on and fight. Hard evidence is warranted in legal cases. The human nature is hard to predict you might think, “this will settle down,� two weeks later you could be called into the office and berated. My journal entries were helpful, they could have been more diligently documented and that happened because I became complacent with the conflict. Do not underestimate the malice or vindictive nature of some human beings. The hard copies of my emails went missing hence I lost some hard evidence.

Stay true to yourself, I urge you to seek counselling, develop a network of allies within the construct of where the incidents are taking place; sometime that can be a saving grace, and I pray you have supportive family and friends.

This tribute to the many who have borne the brunt of bullying lays heavy on my heart, as I am well aware of how the crime has affected me. The hair stands up on the back of my neck whenever I hear of an incident, and it brings me to tears when I hear the tragic news that some dear soul has taken their life because of bullying. It was never intended that the human race treat each other with the malice and cruelty that has been perpetrated towards them. The trend must take a different turn. The animal instinct in us emerges to the surface to establish a lack of empathy, the need to control, and to institute territorial abusive behaviour towards each other. In order to advance toward a functional and progressive environment we need to begin by teaching mutual respect and care for fellow human beings in the home. At a second tier schools, universities and colleges should emphasise the value of others and the importance of social issues by introducing the subject as part of an education plan. Finally at the top level employers, organisations, all leaders and governments must be proactive to legislate and focus on the need to create change 174

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in the human approach and mindset; by emphasizing awareness of, “do unto someone as you would have done unto you.� Only then will we be able to truly instigate a road to harmony. As as far reaching as that achievement may seem, all it takes is each individual to take on the mind-set and be responsible, then as a race and as individuals we can reach our potential.

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CHAPTER EIGHT

Bullying and the Law

8.1 Legislation against Bullying in the workplace While it may be immoral and unprofessional it is not universally illegal for managers or peers to threaten, insult, humiliate, ignore or mock employees. Nor is it illegal to gossip and spread rumours, withhold information, or to take credit for someone else’s work. (Sanders et al. 2012). A grey area faced by many an employee in the workforce.

Individuals can attempt at manipulating the law, so that their experience in the hands of the bully can be perceived that a lawful act has been broken. Try as they may, finding a legal mandate to establish that the law has been violated is like “needle in haystack� scenario.

This chapter highlights and challenges lawmakers to ascertain a legal bundle that will protect the victim of bullying. As this chapter unfolds it will be evident that perpetrators of bullying have broken the law. However to legally bind them to a crime? There is a long way to go before progress and optimum outcomes are achieved.

Legislation is defined as the process of making or enacting a positive law in written form, based on a particular formal procedure by a branch of government constituted to perform this process. On 177

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the other hand a bylaw can be defined as a rule or administrative provision adopted by an institute for its internal governance and its external dealings (Baron 2009).

8.2 Difficuilty establishing bullying legislation G. Namie and R. Namie (2000) outline the difficulty that nurses face when involved in a legal case related to bullying behaviour. It is only when nurses have been unlawfully discharged or have met the criteria of protected custody that they have sufficient grounds to build a legal case. Therefore, it is of paramount importance that, if bullying is to be viewed and treated as a crime, then specific legislation needs to be assigned by governments to bring justice to this heinous offence.

Bullying and harassment fall in line with “intentional infliction to cause emotional distress” (IIED) and the “Healthy Workplace Bill” (HWB) legislation created by David Yamada and passed in 2004. The HWB is now a fixed legislation in use, either in modified form or as created by the author, in most of the United States.

The legal landscape surrounding bullying is still new and evolving (Sacco et al. 2012). A careful review of the literature clearly identifies that bullying practice is growing faster than legislation can be established; a situation to cause concern. Consequently there is a time lapse between reported incidents and a satisfactory resolution for the victim. This situation becomes problematic in terms of providing adequate support and screening those who are most in need of an intervention. Legal laws are not evolving quickly enough to keep up with the high frequency of bullying incidents and the levels to which bullying offences are being perpetrated. The laws are moving in slow motion when it comes to establishing a legal platform 178

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to protect victims of bullying. Employers must be put on notice and be made to understand that they are accountable for the welfare of their employees. Because the law is not “bully-specific,” Sanders et al.

(2012) draw attention to the fact that victims must try to fit the facts into existing legal categories if they want to seek litigation.

The primary purpose of the HWB legislation is to take action in cases where evidence of an abusive work atmosphere or reprisal exists. The legislation was formulated to fight unlawful practices that can be affirmed against the employer or peer on liability grounds.

8.3 Europe proactive to create legislation against bullying On an encouraging note, the literature confirms that several countries in Europe have taken on some form of bullying legislation, with Sweden in the lead since 1993. In its regulation and law against victimisation at work, the Swedish government enforced law against victimisation on 21 September 1993 as an occupational health and safety initiative. The Swedish system forbids “recurrent inexcusable or noticeably adverse actions against individual employees in an offensive manner which can isolate, cause distress and harassment to the employee in the workplace” (Hoel and Einarsen 2010). France, on the other hand, bans repeated acts “of moral harassment, that can cause or impair the employee’s rights and dignity, as a result affecting physical or mental health” (Lippell 2011).

The European Union believes it has addressed bullying in its safety and health initiative, although some commentators argue its usefulness. The directive acknowledges the right for every worker to practice in a safe environment; however, it does not include 179

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psychological trauma, a regular consequence of bullying. The criticism is that, while it broadly includes physical risk, it does not appropriately address psychological and emotional damage (Lippell 2011).

8.3.a United Kingdom England drew up an anti-bullying legislation in 1997, the Protection from Harassment Act. The logic was that, if a person experienced events that were witnessed by a reasonable person who considered that the conduct amounted to harassment, this was sufficient evidence that there was a breach of the act. The act received notice in 2006 when a court ruled that $1.6 million be awarded to an employee who was excluded, given heavy workloads, and experienced offensive behaviour by co-workers.

8.3.b Australia In Australia, legislation does not effectively address anti-bullying.

However, workplace bullying is emerging as a legal claim through fitting categories of legislation around bullying practices like duty of care, harassment, and intimidation. Current discussion confirms the belief that, as more regulation is brought to the forefront and, hopefully, as pending legislation is passed, the claim may get a boost (Von Bergen and Soper 2005). Other existing legislation includes the Occupation Health and Safety workers compensation laws, civil rights, and breach of contract. The difficulty is in proving that what the victim has been through applies to one of these categories. The court will then decide. Recently, on 18 July 2013, the television news reported that the Australian government is considering a threemonth jail sentence for convicted perpetrators of bullying incidents.

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Under the Victorian Occupational Health and Safety Act of 2004, employers are required to provide a healthy and safe work environment for their employees. This includes ensuring the security of the staff, patients, and others. Employers are also obliged to put into place effective policies and procedures to prevent and manage violence and aggression in the workplace. Under the act, employees are obliged to take reasonable care for their own health and safety or of others that may be affected by their acts or omission of their acts.

In addition, they must cooperate with their employer to comply with requirements. Under the provisions of the Victorian Crimes Act of 1958, offenders may be liable for prosecution of assault if they are found guilty of an incident of aggressive or violent behaviour.

8.3.c Canada The Canada Safety Council (June 2004) states that employees experiencing psychological harassment (bullying) may begin to file complaints with the Quebec Labour Standards Commission. The Psychological Harassment Prevention Act (2003) is the first antibullying law in North America. Its success depends on conscientious employers to take action against psychological injury, forcing bullies to be held accountable.

A law is only as effective as its implementation; however, it is worthwhile to have laws in place, as it makes employers take notice and assists in reassuring victims that guidelines have been introduced for their protection. The new Quebec law forbids psychological harassment, which is defined as “vexatious behaviour.� Hostile or inappropriate mistreatment of a colleague is considered to be in breach of the law.

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8.4 Overview Belgium, Quebec, South Australia, Finland, Denmark, Sweden, and some Brazilian states are all reported to have adopted some form of bullying legislation (Sanders, Pattison, and Bible 2012). The Swedish approach requires employers to incorporate policies and procedures to deal with prevention and correction of bullying. The aim is not to “compromise the employee’s professional future.” Violation of the law carries civil damages and criminal punishment up to one year in prison (Hoel and Einarsen 2010). The toughest—in fact only—law that truly makes the bully answerable and accountable is one that imposes a jail sentence. There is no better deterrent for a would-be bully than a prison sentence for a crime committed. It appears that Sweden, unlike other countries, has been proactive in administrating stringent guidelines to prevent bullying in the workplace.

While the world boasts its legislation against bullying, the fact remains that, in 85 per cent of bullying cases, the employer wins, as revealed in a 2006–2008 study of 554 victims (G. Namie and R. Namie 2004). Unfortunately, worldwide there is a significant absence of specific laws to declare, bullying to be a legal offence.

The various forms of bullying, as presented in a court of law, include psychological harassment, duty of care, intimidation, and victimisation related to health and safety or to the Healthy Work Bill.

As a result, in court, the law can twist and turn events to go against the victims; employers, who usually enjoy the support of powerful insurance companies, have the capacity, in a court of law, to argue themselves out of all accountability for wrongdoing. It is therefore understandable that the employer wins the majority of all workplace bully cases.

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In Teresa’s instance, the document that was developed after the assessment by the hospital’s occupational and health insurer leaned heavily in favour of the bullies. The untruths in the document revealed to Teresa that she was fighting a losing battle. Obviously, insurers do not want to make big payouts to victims, and independent legal action is expensive for a mere salary or wage earner. Legislation needs to be well defined and should clearly explain the term “bully.” The difficulty has been that the elements of the legal theories upon which bullying victims have most often relied are so stringent that plaintiffs have had difficulty in meeting their burden of proof (Yamada 2004).

8.5 The Free World The US reflects a low statistic, with reference to managing bullying in the workplace. Yamada (2004) draws attention to that fact by pointing out that, although bullying is “the most neglected form of serious workplace mistreatment in American employment law,” the United States lags behind many parts of the world in addressing it.

It is possible that coming to terms with its existence is difficult when individuality, assertiveness, masculinity, achievement, and higher power disparity are seen as traits of advantage in American society (Haselhuhn 2005).

The downside, however, is that bullying behaviour can flourish in an environment that values traits such as assertiveness and individuality, and this could very well be the reason for higher rates of bullying in America, as compared to other countries (Martin and LaVan 2010). It is suggested by the authors that issues such as a perceived status, a power imbalance, a lack of policy against bullying, and an absence of reprimand can encourage a breeding ground in 183

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which the bully can thrive. Particularly disconcerting is the fact that bullying incidents continue to rise in the United Sates, as Martin and Levan point out, that unless innovation and best practice is explored, the practice of bullying victims will reach out of control and make the problem far more difficult to resolve. Overall the US is the nation “where it all happens.� Hence, one would expect it to be an innovator in establishing bullying legislation. American leaders must come out to confront and attack bullying in its true reprehensible form, initiate substantial legislation against the crime, and pursue it with passion so the rest of the world will take heed.

Youhana (2008) wrote about a poll conducted by the Workplace Bullying Institute, Zogby. The survey that followed revealed that more than 50 million people say they have been bullied at work, which is more than a third of the American people. (Astounding!)

These statistics provide sufficient proof that leaders need to be proactive and must aim to tackle and reduce the problem.

The title of the Healthy Workplace Bill (HWB) suggests simplicity; however, it covers a wide range of bully-related incidents in the workplace. Yamada (2004) has made ardent efforts to tackle the perceived problem of abusive behaviour at work. He has reviewed the shortcomings of current procedures and has identified limitations employers may face. G. Namie and R. Namie (2004) and Yamada have been the principal advocates for legislative action. For the issues to stand up in court, under the terms of the HWB, an abusive work environment requires the presence of acts or omissions (judged by the reasonable person’s standard) perpetrated by any employee of the employer, management, or co-employee. There is more work to be done if America is to be on the world panel to advocate against bullying in the workplace.

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8.6 Advice by authors with strategies Confrontational bullying is addressed in legislation by most countries, in an effort to resolve intimidation and harassment in the workplace.

However, a major subset of bullying comprises coercive behaviour towards a victim, therefore, it is of value to endorse what Sacco etal.

(2002) accentuate in their world project, the recommendation made is that legislators and employers be aware of coercive tactics, as this behaviour can cause major psychological injuries. It is hoped that results will eventually be rewarding in terms of addressing the subtle coercive bully, one who calls victims into the office and carries out a dressing down, ignores, excludes, withholds information and hands out inordinately difficult tasks. Positive outcomes will be achieved when the scheme of coerciveness that underpins bullying can be addressed with a strong move in the direction to seek a resolution to this subtle vindictive crime.

Bullying borders on “hate crime.� The literature defines this type of crime as one perpetrated towards a group, particularly individuals of a different colour, religion, gender, sexual preference, or age it is based on intolerance and non-acceptance, resulting in hostility towards the victim (Omolfe 2011). The act must be a crime under the criminal code of legal jurisdiction and must have been committed with a bias intent (Omolfe).

An overview of state anti-bullying legislation, a world project by Sacco et al. (2012), resulted in recommendations for legislators and employers. Highlights of the recommendations follow: 1. A regular review of workplace health and safety is required to determine the ability to recognise workplace bullying.

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2. Both private and public sectors should ensure that codes of conduct, education of management and nonmanagement employees and suitable workplace behaviors are conscientiously implemented. It is of utmost importance that manager training problem solving, strategies, mediation techniques are addressed. Other topics to that list should be objectivity, a non bias attitude and diplomacy.

3. Applicable measures need to be established to report and scrutinise claims of workplace mistreatment.

4. Human Resource departments should be encouraged and educated in the investigation process and must ensure that allegations are examined appropriately.

5. Grievance procedures must be established and explained to employees who are unsatisfied with the investigation of their claims. Information related to the investigation of the grievance should be available to both victim and bully.

6. A work culture should be regularly reviewed to ensure it is not contributing to bullying standards.

7. All employees should have access to employee-assistance programs.

8. Long-term absences from work should be monitored to identify any stress-related workplace bullying.

9. Rehabilitation coordinators should be encouraged to assist in monitoring workers’ compensation claims to determine whether the claims are related to bullying.

10. Reporting mechanisms established between HR and senior management need to be effective in reporting workplace bullying, and senior management should support procedures and practices to alleviate workplace bullying.

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Many practitioners believe that bullying law in its full form is synonymous to a toothless tiger. It is therefore timely to reverse the cynical mindset and utilize the law as a catalyst to change. Ultimately, the responsibility for remedying the bullying problem lies at the feet of employers and governments.

Identifying bullying and addressing its impact, therefore, is crucial for not only maintaining a productive atmosphere but also for eliminating potentially costly lawsuits (Von Bergen and Soper 2005).

Specific stringent legislation will create disincentives for those with bullying tendencies. Furthermore, the establishment and development of set protocols, as well as diligent observation of the workplace and employees, will reduce the number of bullying incidents. Employees need to be reassured that they are in a safe and healthy work environment. Bullies need to know they are being observed. This type of environment will not only increase productivity, but it will also reduce sick leave and raise staff morale.

Although this would not result in the overnight disappearance of bullying, it might alter the landscape enough that more employers would feel compelled to adopt policies, forbid aberrant behavior, and encouraged to take on proactive and prevention strategies. As a result, the bully would have an incentive to behave in an appropriate and professional manner because not only big brother is watching, but far better, there is an intrinsic awareness and transformation, with a move towards the notion that bullying, intimidation harassment and control is wrong!

Legal responses and mandates, at their best, can only facilitate the harder non-legal work that employers must undertake to create a kinder, braver world (Yamada 2004).

With current legislation, the law plays an important but partial role in addressing bullying (Haselhuhn 2005; Keiseker and Marchant 187

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1999). Bullying is not a problem for Human Resources and lawyers to resolve, they are responsible for paying up after the lawsuit has been settled. The organisation’s managers are accountable for preventing bully behaviour. According to Von Bergen and Soper (2005), employers need to take appropriate action to protect their valued employees. The absence of an organised plan and enforcement grounded in zero tolerance of bullying will only serve to encourage the creation of a hostile litigious environment. Eradicating bullying is not “just something to be wished for. It is something that must be accomplished�.

Yamada (2004) has been proactive in solving the problem of bullying in the workplace. He has made strong attempts to change the culture and believes, like several of his colleagues, that the work culture is a primary source for breeding bullies. Goals developed by Yamada to establish a legal bond that should deter bullying follow.

1. Prevention: The law should encourage employers to use preventive measures to reduce the instigation of bullying.

This would benefit workers and employers and reduce litigation.

2. Self-help: The law needs to protect and encourage workers who resort to self-help measures if bullying occurs. The law also must provide incentives to employers who respond promptly and effectively when informed of incidents of bullying.

3. Relief, compensation, and restoration: The legal system should provide relief to bullying targets if self-help measures are inadequate and enable the targeted victim to return to the job with the assurance that the bully has been reformed or removed.

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4. Punishment: Bullies and employers who put themselves in positions that allow them to abuse their co-workers should be subject to punitive measures, for this will deter future misconduct. One hundred and twenty supporters of the adoption of the Healthy Work Bill (HWB) believe that this would assist to correct the goal to reduce bullying, as well as to make employers accountable and responsible, as the bullying issue always starts at the top, either through perpetration or encouragement of the act. Yamada (2004)

8.7 Constructive Dismissal According to James (1975), court findings in an Ontario Court of Appeal ruled that progressive discipline, if unjustified, could be viewed as constructive dismissal. “Employers should make sure they have all their facts in place before gradually disciplining employees if they want to avoid a constructive dismissal suit,� says Howard Levitt, a labour and employment lawyer with Lang Michener, Toronto.

The ruling means that employers should investigate performance problems thoroughly before implementing a series of disciplinary actions, and they should give employees a chance to respond before proceeding further. The lawyer emphasises that, when a supervisor wants to discipline an employee, it should be first considered whether that person has a personality conflict or an axe to grind before he or she is allowed to go down that road. The legitimacy of the problem first must be determined. If every employer follows this principle, bullying and intimidation would come under the scrutiny of seniors, and the problem could be teased out.

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It is increasingly common for employees to quit or resign due to harsh and unreasonable employment conditions placed on them by their employer (Bohlander and Snell 2004). Hence, they are forced to resign because of intolerable working conditions imposed upon them by their employer. Put simply, the employer has placed the employee in working conditions so irrational and biased that the worker has no alternative but to resign (Bohlander 1999, 2000).

8.8 Power hungry The literature clearly defines the bully as one who is power hungry. In Teresa’s experience with almost every bully she had dealt with, power served as a catalyst for their behaviour and seemed to originate only with managers and team leaders. Peers were guilty of the perpetration; however, the general aberrant behaviour was associated with seniors.

An enlightening revelation by Doyle (1995) who articulates the fact that power is seen as real or perceived. “Harassment is about power, real or perceived, and it is used to make people do things they do not have to, or stop people doing things they are entitled to do.”

This perception comes from both parties involved. The bully thinks he or she has power to continue his or her inappropriate behaviour, and the victim perceives the bully as having the power to make him or her feel inadequate and intimidated. The author describes this correlation well.

In general, the literature reviewed suggests that, if the employer deliberately makes an employee’s working conditions so intolerable that the person is forced into involuntary resignation, then the employer has become involved in constructive discharge, is liable 190

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for illegal conduct, and has formally discharged and aggrieved the employee (Bohlander and Snell 2004).

Although perpetrators and victims are generally identified in these laws, some authors also draw attention to the responsibilities of bystanders who videotape or participate in public fights.

Responsibility is placed on those who watch or are aware of the incident. The consequences for their neglect to act in a pro-social manner in these situations it is disconcerting, as their assistance may help reduce bullying, given that bullies are highly influenced by their peers.

8.9 The financial cost of bullying One of the monumental effects of bullying would have to be the massive impact it has on finances in every institution, through sick leave, counselling, time spent in meetings and overall workplace disharmony that leads to non-productivity.

Harrison Psychological Associates reports that employers’ costs associated with bullying within a two-year period can escalate to as much as $180 million dollars in terms of lost time and productivity.

One person ran a cost of her personal experience of bullying through “Dana Measure of Financial Cost of Organizational Conflict.� It estimated that the cost of her bullying event, based on a six-month period within an overall bullying time frame of several years, was $300,000 (Parris 2007).

Rayner et al. (1999) calculated that, an organisation of a thousand staff members with the current incidence of bullying, an employer can expect to hand out $1.2 million (US). This estimate did not include litigation should victims bring suits against the organisation.

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Kivim채ki et al. (2003) revealed that, in a Finnish study of more than five thousand hospital staff members, those who had been bullied had 26 per cent more certified sick leave than their counterparts who had not been bullied. High staff turnover, retraining costs, damage to employee health, absenteeism, sick leave, workplace violence, and wrongful termination impact astronomically on the workplace.

Edmond (2013) reports on an the incident of bullying in which the courts sanctioned a payout of $600,000 to the victim who was repeatedly bullied by her boss. Despite incidents being reported, nil action was taken to resolve the situation, another costly pay out for the employer.

According to the National Institute of Occupational Safety Health (NIOSH), mental illness in the workforce leads to a loss in revenue of $19 billion and a drop in productivity of $3 billion. As mentioned earlier, bullying results in emotional strain, depression, anxiety, and several other mental illnesses.

The Australian Nursing Federation (ANF) (2005) reports $1,387,408 spent in damages to staff and patients. It is difficult to differentiate the cost related to actual bullying in the health system, as figures are unavailable. The ANF points out that the Work-Cover ACT estimated that bullying in the workplace, inclusive of absenteeism, legal proceedings, loss of productivity, and staff turnover, costs Australian businesses between $6 and $13 billion on an annual basis.

The average cost of stress claims is $41,186, while costs associated with physical injury amount to $23,441. It is clear that costs associated with stress are almost twice the costs of physical injury.

The Australian Human Rights Commission predicts that the costs of bullying could be even higher when considering those that are hidden. Their online workplace bullying fact sheet estimates the cost to Australian businesses is between $6 and $36 billion.

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Mattice (2010) developed a comprehensive outlay of overall costs to the employer when a bullying incident gets out of control or it reaches higher authority.

Time and Money Spent • • • • • •

• •

Counselling of bully by manager: 80 hours and $8,000 Counselling of victim by manager: 150 hours and $15,000 Counselling of witnesses: 100 hours and $6,000 Human Resources discussions with managers, bully, and victim: 10 hours and $6,000 Human Resources discussions with executives: 5 hours and $1,500 Human Resources recruiting and training replacement of victim with another employee due to resignation from bullying: $40,000 Training of new employee by department following departure of the victim: 160 hours and $10,000 Advertising for staff to replace the victimised employee: $1,000

The estimated grand total of the costs noted is $83,000. This amount reflects the time before the victim has left the workplace for legal pursuit. It is then that the cost really escalates. Some costs are incurred on the organisation after the victim has left the workplace The pendulum has swung the other way in terms of balance with regard to workplace conflict, emotional damage and related escalating costs; the result being an unproductive workplace. Time for a turnaround if, organizations want to be frugal and productive 193

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8.10 Conclusion Reform for bullying practices is imperative, especially when considering the overall financial cost, the health of those affected by bullying, and, most importantly, saving lives in those unfortunate cases where victims opt to end it.

The cost involved in Teresa’s quest for justice lies somewhere between the amounts mentioned in the above figures (definitely higher than $83,000). However, no remuneration package can compensate for the emotional well-being of the human mind, body, and soul. The literature widely argues that it is far more advantageous to legislate and mandate than to have hefty payouts fractured personalities or fragile health. It is with hope that a message is delivered for a turnaround to truly commence, that common sense will prevail, stringent legislation will be established, employers will be held accountable, and governments will become proactive in stamping out a crime that is subtle, cruel, and very damaging to the human individual.

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CHAPTER NINE

Statistics and Characteristics

Introduction The literature clearly illustrates that, due to the absence of specific legislation, the law does not support the victim of bullying. However, within the constraints, it is considered unlawful, given the broader responsibilities by employers in the workplace (Haselhuhn 2005).

The situation is exacerbated by the fact that, in 85 per cent of bullying cases, litigation results in the employer’s favour. Hence, the victim is placed in a very difficult situation. There is an obligation for nurses and all victims to be proactive, to develop unique skills, and to combat the bully’s criminal behaviour.

At this point, it is of value to equip the victim with some general tools to manage the perpetrator, to review the literature and draw from it the maximum benefit in terms of what the authors or experts have to say regarding the management of the bully.

It is also worthwhile to look at the statistics in nursing (for example, what percentage of nurses experience bullying behaviours) 195

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and to look closely at the traits of both bully and victim, with the ultimate aim of strategically providing both the means to change, if possible.

9.1 Types of Bullying Delms (2009) discusses collaborative bullying. The so-called “frog” (victim) is slowly boiled, so it will be too late when it decides to jump out. This chilling analogy stresses the level of damage that is done to the individual through bullying of this intensity. The author maintains that this kind of bullying can be highly organised if several bully types collaborate on a target. Delmes, defines the behavior as “systematic bullying,” and points out that this pattern is carried when there is a difinitive intent to harm the target. As illustrated in the previous chapters, this is a very similar type of bullying to that which Teresa experienced, to the point that she was forced to resign from her job. Systematic bullying is very damaging because the bully manages to turn all even loyal colleagues and allies against the victim.

Paterson et al. (1997) refer to bullying as behaviour that is difficult to conceptualise because there is no consistent definition in the literature to distinguish bullying from bad behaviour. Overall, bullying in the health care setting is “generalised workplace abuse” that is persistent and/or nonsexual, occurs without physical violence, involves an imbalance of power, escalates from less to more severe behaviours, and results in a negative effect on the nurse (G. Namie and R. Namie 2000). The research confirms that attributes, frequency, duration, and degree of bullying vary but generally encompass overt and covert behaviours (Haselhuhn 2005).

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Three research approaches to bullying dominate the literature: qualitative interviews, descriptive and epidemiological questionnaires and theories, and constructs in organisational psychology, occupational health, and human psychology. Over-reporting and under-reporting may hinder accurate prevalence figures (Paterson et al., 1997). Although demographics and results related to bullying vary internationally, the crime has a significant presence in the general workplace and in nursing specifically (Haselhuhn 2005). Many literature reviews refer to landmark work in Scandinavia, a country that has done much research on the subject and therefore offers large sample sizes across several occupations (Leymann 1990), resulting in powerful public awareness and ground-breaking legislation against bullying in Sweden and Norway (Rayner and Hoel 1997).

9.2 Incidence Quine (1999) conducted a research study survey of nurses in the UK in which victims’ ages, genders, and hours of work were evenly distributed. The survey results indicated that 38 per cent of participants reported being bullied over the previous year, with 42 per cent having witnessed acts of bullying of nurses by other staff.

The report commonly identified senior managers, physicians, and fellow nurses. Sixty-seven per cent of those bullied in Quine’s study attempted to take action, with a staggering 74 per cent unhappy with the results. Findings by Aitken et al. (2001) were consistent with Quine’s, reporting that less than half of the nurses were satisfied with the way administration, Human Resources departments, and unions addressed their concerns. Therein lies the rationale for governments 197

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to lay down the law to employers to act in the interest of the employee by instituting stringent policies that will assist in eradicating bullying in the workplace.

In Australia and New Zealand, similar prevalence rates were found in nursing populations spanning all clinical settings from public to private institutions, critical care, and emergency departments to general care floors (Farrell 1999; McKenna, Smith, Poole, and Coverdale 2003).

McKenna et al. (2003) highlight the dilemma faced by new graduate nurses in New Zealand, as targeted in a national survey.

The study revealed that 31 per cent of the nurses, a majority who worked in inpatient units, experienced severe incidents of horizontal violence from senior staff nurses, resulting in a loss of confidence, self-esteem, absenteeism, somatic (digestive) and psychological symptoms, this situation ultimately led to transfer or termination.

The survey disclosed that nearly half of the participants failed to file a complaint. Only 12 per cent received “formal debriefing, and the majority of respondents had no training to manage the behaviour.�

Equipping the victim with tools to manage the bully is vital. In this instance educators and university lecturers can play a major role in drawing bullying out into the open and developing practice management styles to deal with the problem. Classrooms would be bursting at the seams if universities held electives in strategic management of the bully. Reports have emerged, in the literature that University lecturers have known to to be perpetrators of bullying; to those university lecturers who perpetrate bullying in the classroom.

Shame on you! You should know better!

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9.3 Perpetrators / Incidence Farrell’s (1999) study revealed that perpetrators of bullying behaviours were mainly nurse managers, physicians, and staff nurses.

Of the three, physicians were responsible for the most frequent number of bullying incidents, and nurses were responsible for the most distressing kind. According to Stevens (2002), the Australian Nursing Federation and the International Council of Nurses have addressed bullying in position statements. Additionally, Australia and New Zealand have anti-bullying legislation. (See chapter 8.)

Stevens reports that one Australian study showed a decrease in Australia’s nursing turnover rate from 28.4 to 21.9 per cent; however, there may be other factors responsible for the drop in the turnover rate. Across the globe, there is a much-needed trend amongst nurses to attend to the problem of bullying.

In the United States, research and legislation on adult bullying seems to be less developed, especially that related to occurrences in the field of nursing. As a result, workplaces do not have specific policies that prohibit bullying. The reasons for this is unclear. G. Namie and R. Namie (2000) conducted a study of 1,335 people throughout America and reported that 90 per cent had endured bullying at some time in their careers. Women were the primary victims (77 per cent) and also the primary perpetrators (84 per cent).

It is of interest to note that, of those who sought help from their bosses or from HR, only 18 per cent were satisfied with the results.

Another interesting study of employees at the University of IllinoisChicago revealed that bullying was four times more prevalent than sexual harassment (Richman et al. 1999; cited in Haselhuhn 2005).

A survey of 1,110 Michigan residents by Wayne State University Professors Keashly and Jagatic (2003) revealed that 59 per cent were 199

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bullied at least once by a co-worker in the previous twelve months, with a staggering 62 per cent experiencing severe distress as a result; 42 per cent stated they had experienced bullying at some stage in their working lives.

A study, that consisted, of a random sample of 3,132 men and 4,562 women (mean age of forty), hostile behaviour was experienced at least on a weekly basis by the employees (11 per cent of the women and 9 per cent of the men). In addition, a significant number of employees (32 per cent of the women and 31 per cent of the men) surveyed had witnessed bullying behaviour in the past twelve months (Neidhammer et al. 2009).

Hansen et al. (2006) studied a small Swedish sample (less than five hundred participants) and discovered that 5 per cent of both men and women experienced bullying, while 9 per cent of the women and 11 per cent of the men had witnessed bullying. Sweden has been the most proactive among all countries in the world to combat bullying.

The mandate of a twelve month jail sentence for perpetrators of bullying should be considered by other countries.

The statistics are overwhelming. Von Bergen and Soper (2005) reported that a 1999 study of 1,100 U.K. National Health Service workers discovered that 38 per cent of the participants had experienced bullying. Two thirds of nurses claim to be verbally abused by physicians at least once every two to three months (Greenfield 1999). Rosenstein’s (2002) cited in Haselhuhn (2005) survey of 1,200 US nurses, physicians, and hospital administrators indicates that, on average, 92.5 per cent had witnessed disruptive physician behaviour such as “yelling, raising the voice, disrespect, condescension, berating colleagues, and using abusive language.�

The literature reiterates that physician bullying is more frequent; however, nurse-to-nurse bullying is more distressing (Haselhuhn 200

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2005). There is evidence that disruptive physician behaviour, is responsible for nurse morale, and retention. This statistic is possible in areas like operating theatres clinical areas in which Physicians are the prime clinicians.

Gary Namie’s study (2003) cited in Parris (2003), at the Workplace Bullying & Trauma Institute (WBTI), revealed 70 per cent of people bullied (targets) will tolerate bullying for an average of twenty three months, a lengthy period of time, sufficient to cause monumental damage in a persons life.

Given those statistics by Namie’s study one can understand the condition of Teresa’s emotional and mental state following the experience of bullying incidents over a period of three to five years.

9.4 Disruption to wellbeing Over the past decade, more people have become aware of the important role physical and mental well-being plays in our capacity to process and engage in our social environments (Parris 2007).

Parris points out that the impact of health deterioration and psychological injury does not go unnoticed by employers. In fact, they are overlooked as indicators of work stress, it is for this reason, some authors suggest that Occupational Health and Safety observe for this pattern of behaviour among employees for early detection.

The General Health Questionnaire (GHQ) Scores is an acceptable tool to gauge stress levels that Hoel and Cooper (2000), developed, cited in Parris and Wolfe (2007). A score of four and above will reflect the need to screen for psychiatric treatment (Parris and Wolfe 2007). Occupational Stress Indicator (OSI) scores measure physical symptoms of neurotically stressors (Parris and Wolfe).

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The following is a chart with the Mental GHQ scores and Physical OSI scores for those directly bullied and co-workers witnessing the events from Hoel and Cooper’s 2000 report. The scores clearly show the effects of bullying extend beyond those directly targeted to include the witnesses. The findings show currently bullied are well above the need for psychiatric treatment at 5.6 per cent (Parris and Wolfe 2007) Bullying and Health Outcomes Not Currently Previously Witnessed Occasionally Regularly at all bullied bullied weekly/daily bullied Monthly GHQ

2.62

5.6

3.7

2.8

5.45

6.68

OSI

33.46

43.7

38.6

33.9

43.26

43.34

GHQ score of above four warrants psychiatric treatment.

Parris and Wolfe (2007) draw an awareness to review and understand the GHQ scores and health symptoms listed above. The scores can be of assistance to counselors and other health workers; high scores refer to constant state of emotional distress.

Gary Namie, cited in Parris (2007), draws attention to the seven most important symptoms of chronic bullying, obtained from his study of 1350 respondents, they are as follows:— • • • • •

Anxiety, stress, excessive worry (76 per cent) Loss of concentration (71 per cent) Disrupted sleep (71 per cent) Feeling edgy, irritable, easily startled, and constantly on guard (hyper-vigilance) (60 per cent) Stress headaches (55 per cent) 202

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• •

Obsession over details at work (52 per cent) Recurrent memories, nightmares, and flashbacks (49 per cent)

Parris (2007) gives the chilling and extremely accurate example of her feeling during her bullying experience.

Taking insight from my incident, the best description to explain the bullying experience is someone is ripping you apart and desegementizing your “person” little by little. By the end of what you can handle, you find your self to be the shell of who you were and the world seems surreal. After removing myself from the situation, I had to work very hard for a number of years to rebuild my esteem, confidence and cognitive self-image.

Teresa experienced the same level of worthlessness, dissemination of self and personality change.

The following anonymous excerpt aptly explains for itself the result of bullying and its damage. Taken from the Face book site, Say No to Bullying.

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9.5 Physicians perpetrators of bullying Delms (2009) points out, that the on going belittling and targeting of specific persons are most damaging.

There is strong evidence that physicians are also perpetrators of bullying practices. In Teresa’s thirty-four years of nursing, the main perpetrators have been nurses in Australia, though nothing as severe or chronic as her recent experiences.

In Saudi Arabia, quite a few medical staff members were prone to perpetrate bullying. They would go quite hysterical and speak disrespectfully to nurses. Even some allied health care employees spoke abusively to nurses. The literature describes the physician as a frequent perpetrator of bullying; they generally do not target specific staff and make their lives miserable, nor are they coercive or manipulative. The literature does, however, allude to the fact that physicians are culprits as well when considering the intimidation factor within hospitals; therefore, the issue must be addressed. While their behaviour should not be excused, it does not seem that there is an ulterior motive in terms of malicious or vindictive behavior to their outbursts. They do not target specific persons and do not indulge in the coercive trend.

Teresa’s experience has basically been otherwise. She has seen physicians angry, it is important to emphasise that the angry behaviour is not ongoing. However their persona can be one of sternness and intimidation; for that reason recruitment and retention is affected. On a more pleasant note, with the new school of medical consultants, a majority are respectful and on an equal par with nurses. As evidenced by the manner in which they interact, it is obvious that they respect the role that nurses play in the health recovery of their patients. They (physicians) clean up after themselves 205

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and prepare trollies for complex procedures, they are required to perform and are very diligent when disposing of sharps. This behaviour is very obvious, especially in critical care, an area where Teresa has primarily worked for most of her nursing life.

9.6 Employers held accountable McCleod (2003) disclosed that 16 to 21 per cent of California employees experienced health conditions following bullying incidents. The finding resulted in a proposition declaring that bullying be considered unlawful, further suggestions were made that monetary sanctions be taken against the employer on behalf of all the victims be instituted.

For unknown reasons, the bill did not pass and continues to be revised.

The Workplace Bullying and Trauma Institute has assisted other state lobbyists in Massachusetts, Northern California, Washington, Oregon, and Oklahoma to begin anti-bullying legislation (G. Namie and R. Namie 2004). It is only a matter of time before employers are held responsible to manage this crime and are made to pay the cost of their inability or unwillingness to protect their employees from bullying. Whatever the case, cause, or results, there is sufficient evidence to drill home the truth of the overwhelming number of incidents of bullying in the workplace. Something must be done.

9.7 Misunderstanding Sometimes, a series of adverse exchanges can occur over time, and resentments can build in both parties. This can be the beginning of conflict (Neuman and Baron 2003). When relationships fail, small 206

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or subtle behaviours, like not saying hello or snapping at requests, can be interpreted as aggressive. Tehrani (2003) states there are “perceptions of injustice even when no real injustice exists.” The interpersonal conflict escalates until there is a blow-up that results in an accusation of bullying. That may be the case in specific instances, and these incidents should be dealt with early on.

However, snapping at requests is not acceptable, as there is a code of conduct to which all employees must be held accountable for and to which they must abide by. In the event that a snapping incident has occurred, the person responsible for the behaviour should seek the other person out and say, “Hey, I am sorry if I sounded a bit abrupt.”

Alternatively, the person on the receiving end could seek out the person and say, “I really did not appreciate your snapping at me like that.” The best approach is to deal with the incident then and there or at least as soon as possible. The literature overwhelmingly suggests that the victim should confront the bully at the time of the incident.

In all relationships, interpersonal conflicts with colleagues and supervisors are normal within an organisation. Alternatively, the process of resolving them can trigger stronger relationships, creativity, and innovation (Tehrani 2003). This is true… if both parties are committed to rectifying the situation and if the organisation encourages and supports that kind of culture.

9.8 Organisational culture responsible for bullying Bullying has been referred to as interpersonal conflict. Haselhuhn (2005) denies that fact and argues that to equate bullying with interpersonal conflict is a dangerous risk because it can be perceived as an attempt to normalise bullying or vilify interpersonal conflict. The 207

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author continues by stating that bullying is a complex phenomenon, and while bullies are clearly responsible for their behaviours, investigators have pointed out that organisational culture, the social system, and character traits of both the victim and the bully are contributing factors to bullying.

Araujo and Sofield (2006), Farrell (1999), G. Namie and R. Namie (2000), and Zapf (1999) have come together to strongly advocate that organisational culture and bullying go hand-in-hand and that this is the main contributing factor to bullying in the workplace.

Leymann (2012), one of the founders of bullying research, categorically claims that organisational factors and the quality of leadership behaviour are the main causes of bullying and disagrees with the notion that personal characteristics of the victim serve as an underlying factor. Poor working conditions, inadequate staffing, job stressors, and ineffective management styles can all create a hostile work environment and, as a result, foster bullying behaviour.

Reporting bullying incidents is a must, if the desire is to curb bad behavior. However, nurses may refrain from reporting, as they might concede that a hostile work environment comes with the job (Jackson et al. 2002). With time and awareness, that can hopefully change. If more reporting and recording of incidents occur or are encouraged, governments will be forced to listen and to take action.

A victim’s fear of retaliation may prevent the nurse from seeking help (Rosenstein 2002; Sweet 2005). This situation is significantly evident in the workplace.

Along with the fear of retaliation, a lack of negative sanctions for bullying sends an implicit message to nurses that these behaviours are condoned or denied by managers and administrators (Glendinning 2001; Malcolm 2001; cited in Haselhuhn 2005). This is a very real scenario. (Teresa experienced worse in fact.) Bullies 208

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are under the impression that they will not be held accountable for their actions. Some organisations use the contract system that might assist in screening the bully. The contract system is an effective tool to screen employees. Basically, the worker is employed for a period of time, perhaps six months. The system works both ways. Due to the global shortage, nurse recruits are not concerned about being re-employed. The advantage for the employer is that, if the employee does not practice within the conduct expected, the contract will not be renewed. To attempt to rule out bullying, all employers need to emphasise their stance from the onset. If employers present a firm attitude against bullying and lay out policies and practices to discourage it, all employees would have no choice but to stop and take notice. This would be a good start towards curbing organisational bullying, and the nursing profession would be well on its way to a healthy environment. Bully reform should be part of an accreditation process. This practice needs to come from the top, which forces the argument back into the court of organisational structure.

Offermann and Malamut (2002), cited in Haselhuhn (2005), criticize, that some organisations tend to blame the victim rather than the bully for the problem in the workplace until the victim has little choice but to leave. This would be a case in which organisational culture is grounded in bullying practices, and the bully has the favour of the boss.

Social circles can encourage bullying behaviour (G. Namie and R. Namie 2000; Zapf 1999). The authors point out that several studies reveal that approximately 50 per cent of participants witnessed workplace bullying and did nothing to stop it. This denial conduct perpetuated the act instead of impeding it.

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9.9 Bystanders role in bullying The literature discusses the role of the bystander in terms of being proactive to act. Mandatory reporting would be a solution to the problem. However, therein lies the fear of retribution and a shift of blame towards the bystander, who has tried to do the right thing. Edmund Burke once said, “All it needs for evil to prosper is for people of goodwill to do nothing.” www.brainquote.quotes/e/ edmundburke.html Bystanders are always a worry in situations such as bullying.

The social climate and fear of being the next victim prompt people to mind their own business and carry on with their own jobs. How much better would it be if a few people stood up and said, “This is wrong” (Farrell 1999; G. Namie and R. Namie 2000; Quine 1999). Even witnessing acts of bullying can be traumatic and is “associated with worse mental and physical health than those who had neither experienced nor witnessed bullying” (Hoel et al. 2004; cited in Haselhuhn 2005). When the group at a social level does not criticise bullying, there is a cumulative effect of resentment, mistrust, suspicion, retaliation, and competition (Hasulhuhn 2005). The end result is hostility and a culture that fosters bullying behaviours. In other words, a wide range of negative effects follows.

It is important to emphasise that some strategic planning is needed as a matter of urgency if the intention is to combat bullying in the workplace. The overwhelming recommendation is that policies and practices be in place to attack the problem and prepare the employee to deal with the offence.

Neuman and Baron’s (2003) research found that the reverse of the Golden Rule applied in some hostile work environments.

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them.” History repeats itself. It is an accepted fact that nurses are encouraged into bullying as power, privilege, and status are handed to them on a platter, as it were, and given to the higher-ranked staff members in the workplace. These elite staff members are those who become bullies (Sweet 2005). Power corrupts, and wage differences give persons feelings of superiority. One bully manager constantly reminded Teresa of her inflated salary and conditions. She resented the fact that Teresa had higher qualifications than she had, as well as ten years more experience in nursing, The literature reveals that particular qualities are linked to the bully and the victim. Particularly disturbing is the fact that, based on the literature, traits primarily rest with both bully and victim and, as a result, predispose them to fall into the bully-prone predicament.

The following few paragraphs look at what particular circumstances or situations guide the victim or bully to follow a particular path.

9.10 Character traits of the victim The overall finding is that “once bullied, always bullied.” G. Namie and R. Namie (2002) contradict this by disclosing in a study that 67 per cent of the participants did not have a past history of childhood victimisation, psychological problems, or adult bullying. Kivimäki et al. (2003) reiterate that prior victimisation is a warning that bullying can occur again.

While Teresa was bullied as a child, she was not bullied in every job she had. In her primary role as a critical care nurse over the last twenty years, she was highly respected and well regarded by most staff, patients, and doctors. While there was the odd bully or highly strung person whom she came across, their pattern of behaviour 211

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was directed at everybody. It is also worth mentioning that, with shift work and the rotation of staff, issues can fluctuate, therefore not working with the same person each shift can be an advantage. The major problem for Teresa occurred when she decided to move to a job that was offered as a Monday to Friday role, in one instance, to run a chronic disease program and simultaneously to assist in running a primary and secondary health program. One role lasted about five years; the other lasted three years. While she did not experience bullying throughout her nursing career, Teresa was disturbed to discover that certain traits of the victim identified by researchers were relevant to her character. Desai, Arias, Thompson, and Basile (2002), cited in Haselhuhn (2005), randomly surveyed eight thousand men and eight thousand women in the United States. Findings showed that female victims of physical or sexual child abuse, or both, were at least twice as likely to experience being a victim as an adult (by any perpetrator). Similarly, men who were victims of physical or sexual child abuse, or both, were at least five to six times more likely to experience the crime of bullying as an adult (by any perpetrator).

The worrying statistic is that men are more susceptible to experience further abuse than women are, furthermore the literature clearly states that prior victimisation may increase a nurse’s vulnerability to bullying in the workplace, however no excuse for the bully. Teresa felt there was little chance for her to get away from the crime that had brought her career to a grinding halt.

Smith et al. (2003) and Desai et al. (2002), cited in Haselhuhn (2005), articulate that those at highest risk of being victimised again are the ones with prior history of victimisation. It is a terrible shame that that there is minimal help to assist the victim escape the effects of a crime that has become part of a psychological problem in the 212

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making. Surely, given what the statistics and literature state, there must be a way to break this cycle of events.

Characteristics of the victim include: A. Pre-existing psychological history of depression, anxiety, and social phobia B. Traumatic stress disorder; personality disorders C. Underdeveloped coping and conflict resolution skills D. Unassertive and passive behaviour; avoidance of conflict E. Failure to stand up for oneself; very obliging and na誰ve F. Nice and cooperative; optimistic and enthusiastic G. High tolerance of unhealthy workplaces due to a history of unhealthy relationships H. Vulnerability due to the manner of talking or carrying themselves; previous victimisation I. Conscientious, rigid, and annoying (to the intolerant bully) J. Refusal to be controlled by bully; A possession of skills the bully lacks K. A demonstration of little effort to connect with work group L. Underdeveloped communication skills, low self-esteem, and lack of confidence M. Low sense of belonging and a view of self as different from the group; an inability to defend self or opinions N. Highly suspicious, quiet, less competitive than co-workers; humourless and oversensitive (G. Namie & R. Namie 2000; Quine 1999; Zapf 1999; Haselhuhn 2005)

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The general consensus is that victims possess certain attributes that draw attention towards their quirky (G. Namie and R Namie 2000; Qiune 1999) personalities or any of the above-mentioned qualities. Does that give the bully reason to exert his or her power over a person? Of course not.

Points E-I are traits that, unfortunately, Teresa possessed, for example, naïveté, a friendly manner, vulnerability, and the tendency to be overly nice. In fact, on multicultural days, when food from different countries were cooked and taken in for lunch, she would cook her Indian food and, as a special effort, pack separate meals for two of the senior staff members. Some evenings before the lunch day or after work, she felt tired; however, she would still feel obliged to prepare and take in the meal. On some occasions, she would not as much get a “thank you” from the senior nurses. She was conscientious without being rigid but somehow still managed to annoy her bullies although she had great relationships with most staff, all patients loved her, and she was described as having clinical skills second to none.

9.11 Character Traits of the Bully Several studies have outlined characteristics that may elicit bully behaviour. As the literature discusses, the bully comes with his or her own traits as well, qualities or past experiences that contribute to the behaviour pattern.

What turns people into bullies? One anonymous slogan says, “Bullies are made, not born.” What is it in society, family life, or a person’s upbringing that forces someone to become an intimidator in nature, one who takes pleasure in harming a person emotionally, 214

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physically, takes advantage of vulnerability and niceness, with no real valid cause? These questions and many more are the hearts and minds of many a victim. Studies suggest that schoolyard bullying and childhood victimisation are linked to adult bullying (Desai et al. 2002; Smith et al. 2003; cited in Haselhuhn 2005). The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that some bullies have a personality disorder, which is marked by certain character traits and developed early in life. Haselhuhn (2005) states they often exhibit many traits of different personality disorders, such as narcissism, antisocial behaviour, borderline obsessive-compulsive behaviour, passive-aggressive behaviour, and paranoia.

The American Psychiatric Association (APA 2000) identifies the bully as having misperceptions of themselves or situations and adds that their interpersonal relationships are dysfunctional and their emotions reflect instability and a lack self-control. These are pathological (faulty) in character.

Narcissistic bullies, on the other hand, classically lack empathy and understanding for other people, view themselves as superior to others, and need excessive admiration from others (APA 2000).

They are preoccupied with thoughts of success, intelligence, power, and beauty. One study states that bullies are envious/threatened by those who are “more attractive, confident, successful, qualified, and popular� than the bully (Sweet 2005). Although they are grandiose, their self-esteem is quite fragile. They are easily wounded and vindicate their wounded ego by lashing out, punishing, devaluing, and criticising others. They have a sense of entitlement, expect others to comply, and will manipulate to get what they want.

Persons with antisocial personality disorders may also be bullies.

Ironically, antisocial bullies usually do not lack social skills. They can be charming, affable, and likable in order to con someone into 215

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believing that they are pleasant caring human beings. They are antisocial in terms of not abiding by societal norms/laws and not possessing a conscience. They view others as weak and deserving of abuse Zapf and Einarsen (2003), cited in Haselhuhn (2005).

Character traits of antisocial personality disorders include bullying behaviours before the age of fifteen, lying for personal gain, irritability and aggressiveness, irresponsibility and impulsiveness, as well as indifference towards the mistreatment of others (APA 2000).

Einarsen (1999) describes one type of antisocial bully as “predatory” because “the victim personally has done nothing provocative that may reasonably justify the behaviour of the bully. The predator is either demonstrating power or trying to exploit an accidental victim into compliance.”

Delms (2009) states that one in thirty people is a serial bully. The author articulates a very comprehensive list of traits that comes close to describing the bully. They are predatory, and most are incurable, sociopathic, and dysfunctional. They are mean-spirited and psychiatric in nature (mental disorder) and are often considered to be cowardly. These types of bullies are incurable, and they represent one per cent of the population; hence, they exist in the community in forceful form.

They are also dangerous. Targeted victims can be exposed to subjugated abuse through isolation, manipulation, badmouthing, backstabbing, and criticism. Another dangerous strategy associated with these types of bullies is their tendency to confront, injure, destroy, or eliminate (socially). It is difficult to extrapolate from the literature whether known bullies become murderers; however, it is sufficient to say that most killers would have bully tendencies. Most murders would be considered bullying of the violent kind. Consider the following reported incidents: 216

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9.12 Bullying: worst kind : Murder • •

• •

Two eleven-year-olds abducted and murdered two-year-old James Bulger (Schmidt 1993).

CBC news (27 October 2010) reported the luring of a sixteenyear-old girl by two teenage boys (one of whom she had dated briefly) and her subsequent rape and murder.

A family was convicted of manslaughter following an arson attack in which the parents of a disabled child were killed.

Aussie homes were filled with sadness over the rape and murder of an Irish girl, twenty-nine-year-old Jill Meagher. In 2012, a forty-one-year-old man was charged and convicted.

The news of these violent incidents tugs at one’s heart and causes anguish. The events leading up to the violent attacks and, finally, the overpowering of innocent victims are nearly impossible to comprehend.

It is a foregone conclusion that bullying can take on various forms; rape and murder is also bullying of the most violent and aggressive kind.

In a major study of schoolyard shootings, Unnever (2005) discovered that those who went on a rampage and murdered their schoolmates, teachers and even children had one factor in common.

They were victims of chronic bullying (Vosekuil et al., as cited in Unnever 2005).

The literature also raises serious questions about whether bullies should be held accountable for those victims who commit suicide.

Victims who become so distressed from bullying that they see the only way out is by ending their life. Hopefully, the future will see some rational decisions or legislations related to the determination of who is responsible for these suicides. Better still if suicides are reduced due to reform in bullying.

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9.13 Bullies reoffend Delms (2009) points out that bullies have an intrinsic need to reoffend. That is, they are cautious when it comes to finding another victim so that attention is not drawn towards them. The serial bully will use tact and cunning to lure their next victim, so much so that the victim is unaware of being bullied. The crime is so subtle. For that reason especially, one must be on guard.

Bullies can be male or female. Male bullies are loud, forceful, overbearing, and intimidating. Females are quietly subtle, indirectly forceful, coercive, and intimidating. They can also be mousy, sneaky, and snivelling (Delms 2009). They do not like confidence, faith, courage, integrity, true cooperation, or teamwork. They detest honesty, capabilities, and talent.

Some of them are selective and choose their targets for their own reasons, making them feel powerful or giving them control.

This trait, according to Delms (2009), is specific to the smart bullies, which makes them hard to spot, as they appear to be quite normal in public, for example, spouse bullying. The person may treat his or her partner affectionately in public, being careful to reserve the abuse for the privacy of their home.

It is interesting to note the author’s description of child bullies as being different from adult bullies in that they may lash out initially for attention and out of emotion. Status, salary, or authority, however, motivate adult bullies.

Delms (2009) makes a startling revelation that child bullies will have a criminal conviction by the time they are thirty years of age. Bullies crave control and, as a result, focus on control through fear and other tactics that carefully target the vulnerability of the victim. Bullies will project unsatisfied needs onto others or take 218

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those unsatisfied needs out on others. For example, if they lack social skills, they will do all they can to hinder the socially adept person through the practice of bullying. In a group conversation, they may interrupt and talk over another to make the person feel as though what they are saying is not important.

In Teresa’s case, this scenario happened quite often with one manager who hated the fact that Teresa had a great friendly relationship with the Allied Health. Clever bullies can present a multiple-faced, chameleon-like personality and can play several issues while safely staying on neutral ground. They are disruptive to organisations by creating ill will, bad feelings, and misunderstandings. Delms boldly states that habitual bullies are not dim witted and argues that they just cannot seem to comprehend that their actions are unethical or illegal. Ironically, the law supports this misperception, as there is no “statutory declaration” that emphatically defines bullying as a criminal offence.

G. Namie and R. Namie (2000) state that some people become bullies through accidental means, as they are unaware of how their negative behaviours impact on others. The authors say that these bullies lack social graces and can feel remorseful when confronted.

Their behaviours are adaptable with environmental rewards and punishments. Bullies who fit into this category are pleasant to come across. They back off as soon as their attention is drawn to their behaviour and are quite apologetic.

Substance abusers who develop a personality disorder can be erratic, impulsive, paranoid, and disinhibited in terms of social etiquette (APA 2000; G. Namie and R. Namie 2004). As mentioned, these traits can result in bullying practices.

Everett-Haynes (2011) brings the argument to a head by saying that “a person’s personality cannot be changed” when referring to the 219

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bully. In other words, one is unable to dictate how agreeable a person is to another; however, it is possible to improve levels of compassion to make the bully aware, a difficult task for a culture that has flourished for years. Yet, any start is a good one, and if the outcome is positive, it is even better. Change needs to be embraced, and some authors have taken the time to investigate and offer suggestions as to how incidents of bullying, intimidation, and harassment can be managed in the workplace.

To quote sir Issac Newton some 330 years ago, “for every action there is an equal and opposite reaction.� www.Physicsclassroom. com>tutor>newtons law Despite a law of physics, the metaphor can stand firm in social scenarios. Every perpetration whether good or bad is going to have repercussions and ramifications. The statistics reflect the effects bullying has on the individual and it is not very pleasant.

9.14 Conclusion Teresa failed to practice some of the points suggested in the literature and, as a result, became a victim of bullying. She was not aware of how she could deal with what she was facing. While she is well aware now, after the fact, she knows a better outcome would have been achieved had she devised a plan, invested in the research of policies, and did all she could to stop the perpetration early in the situation.

Quite often, when in the midst of an emotional storm, rationale and clarity seem miles away. For that reason, it is vital that practices and values are grounded in place, so when the storm strikes, automatic control is activated.

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If Teresa had some systems in place, she could have minimised the trauma and emotional distress she experienced on several occasions. Her emotions could have been under control (to some extent), and clarity would have remained. It is with urgency and compassion that advice is offered to all organisations out there, so Teresa’s story and several others are not repeated. Teresa is alive to tell her story. Several other victims, however, are not!

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CHAPTER TEN

Reform and Education

Introduction Nursing covers a wide range of disciplines and health care issues that will always remain at the forefront of the profession and will be in need of constant review and change. Problems such as the nursing shortage, a code of ethics, conflict resolution, heavy workloads, and bullying are some of the issues faced on a regular basis. Reform is inevitable if the future is to reflect a safe and effective health system.

Bullying in nursing is taking its toll on the profession as nurses leave to pursue alternative employment.

This chapter looks at bully reform. The terms micro-reform and macro-reform will be used. Micro reform refers to change that needs to occur at the core of practice, on the other hand Macro outlines the change warranted in a broader sense at management, organizational, or government level. In addition an overview of education is explored to confirm its rightful position, in remediation to bullying practices, so that the key elements for bully reform can be highlighted in the classroom, an emphasis is placed on role play as a valuable instructive strategy to combat bullying in the workplace.

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10.1 Micro Bully Reform The micromanagement of bullying needs to start at the core place of its origin. Haselhuhn (2005) talks about crisis management skills in the short term that could be of advantage during and after bullying incidents to avoid small incidents blowing up into mammoth conflicts. Listed below are some of the skills 1. Speak up.

•

•

•

• •

Avoid spineless flexibility and prevent bullying by standing up for oneself (G. Namie and R. Namie, as cited in Haselhuhn 2005). Bullying needs to stop where it starts.

One celebrity psychologist states that when “we teach people how to treat us, what we accept is what we receive” (McGraw, as cited in Haselhuhn 2005).

Wilkes (2012) suggests that one accept the bullying, change the relationship, or leave the relationship. The author’s advice is valid. It is crucial that, as a victim, one has the clear discernment of when to leave the relationship and move on before irreversible damage is done.

Set limits on behaviour. Use your hand as a Stop sign to say “Stop! You are intimidating me” (Von Bergen and Soper 2005).

Use humour to help diffuse the tension (Haselhuhn 2005).

While the author means well, the suggestion is easier said than done when somebody is belittling and intimidating you or breathing down your neck. At those moments, the last thing you feel like being is funny. However humour can prove to be a handy tool to diffuse conflict if one is of the right mindset.

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•

Use controlled breathing to help calm anxiety. Teresa’s counsellor advised her to take deep breaths, fill her lungs with a maximum amount of air, hold it for three seconds, and then gradually let it out through the mouth. Practice this exercise as soon as warning signs appear. If people are around you, breathe into your shirt, or look away. Aim to do about five breaths at a time. Try not to make yourself too dizzy from inhaling too much oxygen.

2. Help each other.

Haselhuhn (2005) suggests support for each other could, in turn, assist to change an organisational culture and social climate.

Bystanders must change their value base and come out to assist victims of bullies. One hospital used the term “code pink.” To protect the victim, all supporters would gather around the victim when a particular physician would become abusive, and it soon stopped (G. Namie and R. Namie 2000). While this strategy is a great one to put into practice for physicians, it is not as clear-cut when it comes to nurses. Within the nursing discipline, the many factors involved often result in a tendency for witnesses to walk away and pretend the incident did not happen. Retribution is a concern of many nurses, they are well aware that “payback” can be carried out very subtly. The best way to help a victim is to offer support and advice. Let the victim know that you are aware of the situation and wish to be of support.

Report the incident to a higher authority and seek intervention.

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3. Play the game but without compromising your own values.

Narcissists are much easier to get along with if you agree with them and freely offer compliments. Haselhuhn warns they are easily wounded and will lash out. (They are always right!)

4. Seek support.

Farrell’s (1999) study found that the best action after an incident of bullying was to seek support from family. Teresa would not be alive or mentally intact if she did not have a strong family support network. Quine (1999), on the other hand, found that allies at work increased consequences of bullying. Hence, family and networking outside of work can bring relief.

Callaghan (2013) highlights a few tips for dealing with bullies, which are worth discussing, the author, advises:-Don’t get emotional.

Don’t blame yourself. Do your best at work. (This may not always be possible if you are facing intimidation. It might be easy at the start, but all the literature indicates that reduced productivity is among the early negative impacts of bullying.) Document everything. This point must be emphasised, as Teresa’s documenting left a lot to be desired. She would have been in a much better predicament had she meticulously saved, filed letters and emails. Statistics become valuable in the fight against bullying.

Seek help. Get counselling. Authors G. Namie and R. Namie (2000) recommend attempting to “bully-proof” before you “bullybust” someone else because the process can be traumatic. Trained counsellors are best (preferably outside the workplace). They can assist in regaining self-confidence. Counselling is also another way of having incidents being documented by someone with an objective, 226

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independent view. A counsellor’s documentation will also carry weight in a court of law.

Stay healthy and exercise, if possible. (Daily walks are good.) Eat healthfully, and get sufficient sleep, even if it means having gentle medication support. Remember, a good night’s sleep keeps you alert for what might come your way the next day. Of course, if it gets to be too much, see your doctor.

Educate yourself, and read materials (journal articles) on the subject of bullying so you can begin to understand what you are experiencing. Last but not least, Cavanagh reiterates, not to expect the bully to change. Rightfully so, as all the literature leans towards the saying, “Once a bully, always a bully.” Therein lies the fact that the responsibility is on the part of the victim to manage the circumstances by prudently following advice and seeking the necessary help. It is extremely important to evaluate your boundaries and set limits on others. To what extent will you restrict being used by others.

What is acceptable and unacceptable behavior? If you are not happy with the way people speak or treat, you then it is unacceptable.

Do you tolerate the intolerable? normalise the abnormal? Do you know what it feels like to be treated with dignity and respect?

Make every attempt to become aware of unacceptable treatment from others and learn how to set limits on their behaviours when they violate your boundaries. Nipping bad behavior in the bud, will keep your sanity, and you will teach people how to respect and treat you.

5. Keep accurate records.

Records come in handy, especially emails and documentation of phone calls. As soon as it is apparent that bullying is occurring, start a folder and begin documenting incidents. Keep a record of all 227

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bullying incidents, with dates, times, witnesses, direct quotes, and evidences (Richards and Daly 2003).

Locate policies. If your workplace does not have one, ask for help from your counsellor, with whom you should now be in contact.

Locate existing policies that refer to discrimination, harassment, and failure to maintain a hostile-free work environment and an employee’s right to be treated with dignity and respect. These policies are existent in most work environments and can be used to protect yourself (Richards and Daly). The authors continue their advice on the importance of observation and close examination of what does and does not work in certain situations. This can be difficult, as quite often when under stress being rational is extremely difficult for this reason, early intervention is imperative. Get familiar with legislation that could suit your situation; keep in contact with allies.

6. Review your workplace strengths and weaknesses.

Be realistic and inquire of one-self if there is any truth to the bully’s complaints. When exploring these questions, remember that excessive self-criticism leads to depression and despair. Monitor self for suicidal and homicidal thoughts. Also monitor for selfdestructive coping mechanisms, such as overeating or drinking.

Take measures to improve sleeping, eating, and exercise regimens (Haselhuhn 2005).

7. Formulate a plan.

Review options to defuse anger and frustration before approaching the bully (G. Namie and R. Namie 2000). For example, when Agnes approached Teresa on an eventful morning in June 2006, Teresa 228

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should have had a plan as to how she would handle the situation.

Instead, she got herself into an emotional state through the preceding twelve to twenty four hours. Confusion, anger, and anxiety clouded her thinking process, she, was quick to get angry, and lost clarity of the situation almost as soon as Agnes walked in to the office and began to throw her weight around. Self-control is so important in those types of situations. Agnes’s arrival and curt manner fuelled a fire that Teresa tried to put out for three days. Before long, all communication broke down, and the situation deteriorated. There are no winners in conflict.

Wilkie et al. (1996) discuss “hard and soft buttons” with reference to managing conflict, the authors emphasize discernment when it comes to being firm (hard button) or gentle (soft button) while handling conflict. It pays to carry a tone of speech, display a stable temperament and offer an appropriate verbal response to reflect what the authors advocate. The authors G. Namie and R. Namie’s reiterate, to plan before acting, and to, create a platform on which you will handle an incident. Try to remove the emotional aspect of the pending incident and work out your stance. Take the moral high ground and keep calm. Hit the pause button. The authors aptly articulate that, instead of the fight-or-flight response, go for the right response. Doing so is almost impossible in the heat of the moment when confronted with a situation that might take every ounce of self-control you possess to stay calm. The literature in general support that being alert and formulating a plan can prove to be of great advantage, if utilized, these practices can merge to provide an umbrella effect on emotions, anxieties and fears. Teresa found that this approach worked well as a rule. The times she was caught off guard, she found damage had been done. Of course, the longer the abuse continues, the greater the damage.

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8. File an informal complaint.

An informal complaint submitted to the bully’s manager could be the beginning of the end. Make use of the chain of command, beginning with the line manager. Review prior documentation about bullying incidences and prepare a statement. Remove all emotional language from the complaint, and be objective (G. Namie and R. Namie 2000). If the bully is the nurse manager, one must consider that the manager’s boss has protected her from corrective action in the past (Haselhunh 2005).

9. File a formal complaint.

Consider filing a formal complaint to the organisation’s grievance committee. Typically, the committee makes recommendations to the organisation about how the case should be managed and offers suggestions for the due process following the complaint by the victim about the bullying incident in the workplace (Hubert 2003). This will no doubt escalate the grievance procedure and could work both ways; however, action has not always been satisfactory in defence of the victim. A benefit of filing a formal complaint is that it creates a paper trail.

10. Seek legal representation.

If you are still unpleased with the results after filing a formal complaint, as a last resort, consider legal representation from outside the workplace. Attorneys may, however, often tell employees that the bully has done nothing illegal and that no civil rights have been violated (Hubert 2003). In Teresa’s instance, her solicitor was very 230

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supportive and understanding. Hubert alerts that, once an attorney is involved, the workplace will stop at nothing to build a case against the victim. It quickly becomes a downward spiral; therefore, early intervention is the best option.

11. Transfer to another workplace and start anew.

Haselhuhn (2005) suggests this as another strategy for dealing with a bullying situation in the workplace. Moving on to a new workplace is not giving up or giving in to the bully, but it is likened to leaving any unhealthy relationship and looking after number one “you.”

12. Research potential workplaces.

Interview future staff and managers for bully characteristics and unhealthy work environments. Basically, “move on.” Your life and future are of more value than this transient experience.

10.2 Macro-Bully Reform It has been said in the past that, if the small things are taken care of, the larger issues will just fall into place. This is true to some extent; however, in the case of a practice that is constructed at the top, minute detail is always reflected at the core within an organisation.

Organisational structure follows such a model. What happens at the core structure is reflected in the total, whether that total is the human body, a family unit, or an organisation. It is also apparent that a sturdy, well-built umbrella will protect against rain and will not collapse in a strong wind.

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It is clear that bullying brings destruction and disarray to an organisation. An organisation that embraces, change, promotes fair practices, constantly evaluates and implements best practice based on ethics will reverse the disorder that bullying brings to a business/culture/ or company. Managers and leaders, hence, become accountable and are expected to follow principles set up by the organization.

Haselhuhn (2005), advises, that carrying out a survey of nurses both at local and national level will provide leaders with convincing data to facilitate change. Haselhuhn continues that in the light of statistics and measurable outcomes, the end result could reveal a varied lot of qualitative information that can assist in the enforcement of public policies against bullying. Survey nurses, at both a local and a national level, and provide data to convince leaders of the need for change. The author advises that reviewing a study that shows statistics and measurable outcomes, which could reveal a varied lot of qualitative information, can assist in the enforcement of public policies against bullying in the workplace.

Setting up a workplace violence team within hospitals is another way to deal with bullying in the workplace (Haselhuhn 2005; Richards and Daly 2003). The authors suggest that the team could be responsible for developing an anti-bullying policy and procedures for lodging complaints and sanctions against bullies. Occupational health nurses could work in this capacity. The limitation would be that the power of the organisational hierarchy would restrict their role.

Hoel et al. (2004), cited in Haselhuhn (2005), recommends a dispersal of information through brochures about bullying for nurses in all areas of nursing. Sweet (2005) reveals that one Australian hospital created a video about bullying. They also developed annual 232

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mandatories and quizzes about recognising and reporting bullying.

The authors emphasis that it should be mandatory to report bullying, or encourage nurses to report every incident of bullying through the creation of a confidential reporting system.

Hubert (2003) points out that organisations need to hold bullies accountable for their actions and enforce a zero tolerance policy.

For example, an Idaho hospital fines physicians $10,000 for each angry outburst that occurs. In addition, those who do exhibit angry outbursts are required to attend an anger management course (Araujo and Sofield 2000; cited in Haselhuhn 2005).

Haselhuhn (2005) encourages lobbyists and lawmakers by suggesting they gather anecdotal and evidence-based research to confront national legislators with the intent that proof itself will compel them to improve laws in the hope that victims of bullying will be protected.

In an attempt to target bullying, Von Bergen and Soper (2007) developed strategies to target the big platform of seniors within organisations. The authors suggest the following: 1. Establish organisational values for dignity.

2. Demonstrate respect for all workers; develop a policy on workplace bullying.

3. Pay attention to new employees 4. Adopt a 360-degree performance appraisal system.

5. Distribute the policy related to bullying in the workplace to all employees.

6. Monitor turnover rates, and conduct confidential interviews.

7. Perform regular employee satisfaction surveys; reassure employees that confidentiality will be protected.

8. Conduct exit interviews to locate problem areas.

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9. Provide training in social skills and interpersonal communication.

10. Take claims of bullying seriously.

11. Prevent and monitor attempts to retaliate against the target for complaining.

12. Institute a complaints procedure.

Following a study, Simons and Mawn (2010) submitted a presentation on bullying to the nursing profession and offered some valid advice, worth passing on. The authors concluded that workplace bullying has profound negative effects on the health and wellbeing of individuals, which in turn translates into a considerable economic downturn for an organisation. The recommendation made is that occupational health nurses intervene to provide policies for the health of employees. In addition they suggest that an overall strategy be implemented to overcome the substantial problem of bullying in nursing.

Wilkie (2013) reports that one in four nurses experience bullying practices in the workplace. Occupational health nurses should be encouraged to develop programs to prevent bullying and to provide support to those who are victims of this crime (Simons and Mawn 2009).

To equip nurses to deal with the bully is a formidable task.

Clearly, the problem is significant. Several researchers are eager to see change, and many have attended conferences, have spent hours on studies and reviewing data to highlight the fact that there is a very real problem in the workforce and that bullying permeates the hospital system. The facts gathered by several authors, the data written, advice given, and suggestions made regarding this subject provide encouragement and the knowledge that there is concern about the cultural nature of the nursing workforce. The financial 234

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drain bullying takes on scores of organisations is reason enough for action to be taken. However, it appears that psychological and physiological injury is forgotten or left behind in the statistics.

Human compassion and empathy is embedded in every individual.

Bringing the issue of bullying to the forefront is the responsibility of parents, schools, universities, and, last but not least, organisations, need to take on an obligatory approach. The literature widely states that bullies are not born they are made, therefore the task lies with those structuring and teaching behavior patterns, beginning in the home, parents take heed to maintain a productive and happy workplace.

It is with passion and courage of conviction that a plea is put forward, to work hard, instill positive values, rule out bad behaviour, and to advocate that a humanistic attitude, be considered to all persons affected by bullying. In addition it is important that practices and policies are established and progress of a bully-free or at least a bully-aware society is monitored. It is imperative that bully reform points are reviewed both at a core (micro) and management (macro) level. Every unit responsible for human behaviour must take heed and practice the suggestions made by several experts, who have gained credibility through exploring and research in a field where the individual. The individual is prevented from functioning normally because of a crime that is preventable and able to be managed. It is vital to implement anti-bullying regulations in work practice and encourage a team spirit that supports each employee. Tables one and two highlights the discord within organisations.

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1 effects of discord in Organisational Structure

Organisations work Culture: illustration where undermining and espionage is occurring Leaves

Mistreatment from co-workers/ Management Employee trust/Loyalty diminished

Disgruntled employees Employees speak negatively about poor leadership and management Impacts on Organisational Integrity. New desirable talent avoide employment with organisation

Stays

Strategy not implemented through employees actions. Imaocts on strategic planning.

Impedes process

Workforce speaks negatively about experiences to others in industry. Impacts organizational branding

Employee reveals propriety information.

Impacts on organizational intelligence.

Undermines risk management

Taken from Parris, Wolfe Associates (2007) Parris.research@gmail.com

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Effects of Discord in the Organisational Structure Discordant Individual conducting evaluations and reviews- impedes succession planning and impacts strategic planning.

Senior Management/Manager Discordant individual

Decision Maker (DM)

Inaccurate team evaluations

Impacts Strategic Planning. *�DM� shielded from identifying valuable employees. * DM, unable to assess organisations actual capacities

Poor Performance Reviews

Impacts succession planning. *Improper promotions/demotions hinders succession planning strategies. *Loss of talent access; innovative and creative thinkers leave from lack of opportunity

Taken from Parris, Wolfe Associates (2007) Parris.research@gmail.com

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Impacts Human Resources. *Improper performance reviews, hinders *Organisational growth *Teams confidence and esteem development. *Workforce motivation

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Harmony in an organisation results in open and honest communication, a strong work ethic combined with a strong team spirit, respect for each other, healthy/productive conflict/debate, and people working towards similar strategic goals.

Strategies are properly implemented because of strengthened interpersonal infrastructure, overall achievement being productivity (Parris and Wolfe 2007). When an organisation identifies and successfully addresses these issues inside their workforce, they: • • • •

Preserve a positive work culture Instil a sense of trust and accountability of senior management.

Create a work culture that incubates innovative and creative teams who share knowledge and are solution oriented Retain desirable talent and turnover cost (Parris and Wolfe 2007)

10.3 Education Merrill (2002) articulates that learning is achieved when students are engaged in solving real world problems, when existing knowledge is activated as a foundation for new knowledge, when new knowledge is demonstrated to the learner and when knowledge is integrated to the learners world.

It is a well-known fact that knowledge is power. Training, education and basic nurturing will remain a catalyst to the coping mechanism in most challenging situations. It enhances managing the work-pressured environment, equips and empowers the individual to practice in confidence, improves self-esteem and establishes credibility.

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Merrill (2002) sheds light on education when he points out that, learners who have pre learnt knowledge of materials to be taught, will have an intrinsic experience waiting to be activated by an opportunity to demonstrate what they already know. The author claims that this activity can be used to guide or steer students towards experiences or practices and hence result in a more efficient instruction. Therefore, role-play in terms of teaching the learner to deal with bullying can serve as a valuable tool, as most people have been exposed or are aware of bullying practices.

Merrill emphasizes on the importance of reflection in learning; and endorses the benefit of discussions when he promotes a view, knowledge or skill. On the other hand, the author points out that creative learning is promoted when learners can create, invent, and explore new and personal ways to use their knowledge or skill. The learner who has been equipped in the classroom and taught how to deal with bullying can feel empowered to practice the skill when adversity strikes.

Swimming with Sharks “Swimming with sharks� with reference to the bully and conflict appeared regularly in the literature. It is therefore of relevance to draw out the analogy so victims can use it as an awareness tool.

When it comes to bullying, the learner needs to be focussed and aware of behaviour patterns, and impressions that one can unwittingly leave with co-workers. The swimming with sharks, analogy draws together that awareness and aptly describes a scenario worth applying in the workplace. This analogy articulates awareness of potential trouble in the workplace and as a learning strategy, can equip employees with the tool to manage bullying in the workplace.

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Hut (2009) gives insight into the fear of swimming with sharks, not a sport for the fainthearted, only for the experienced swimmer.

Obviously, the shark is the bully! Hut articulates that the instruction is written primarily for the benefit of those by virtue of their occupation find that they swim in water infested with sharks. Nursing, as evidenced throughout this book, is one of those occupations. Having said that, the literature clearly indicates that bullying is widespread and global. In the analogy, the author suggests: •

•

•

Assume all fish (co-workers) are sharks. Hence, be on your guard. Advice is given to the injured to “not bleed” if injured. It is a cardinal principle to stay composed. Bleeding triggers further attacks. Therefore, the experienced swimmer stays composed.

Promptly address aggression. This will almost invariably stop or prevent a full-scale attack. The action also informs the shark that you will take whatever force is necessary to resist aggressive actions. Some swimmers may believe that an ingratiating attitude will dismiss the attack. (The author makes the chilling comment that those who hold this view could lose a limb.)

Disorganise an organised attack. Divert an attack by introducing something minor or trivial to set off conflict among the attackers. Again, this advice is pertinent for the experienced swimmer and not for the novice. The best advice for the inexperienced swimmer is to get out of the water.

The analogy holds firm the belief that there is severe injury when exposed to conflict. Hence, the advice is to recognise what is coming your way and act with urgency to prevent it. Be on guard in the face of adversity, hang onto an inner strength, aim for self-differentiation 240

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(Fischer 2010), and stay diligent to act promptly. Clearly, the advice related to conflict is relevant only to the experienced worker, which leaves the recruit in the lurch, unsure and bewildered at what is coming his or her way. The literature clearly illustrates that conflict in the workplace is a global issue. That is sufficient reason to teach bullying prevention strategies in the classroom and equip future employees to manage disagreement in the workplace.

10.5 Role play Nelson (1999), cited in Merrill (2002), emphasises that solving problems is based on application rather than demonstration. There is strong support in the literature that role-play is an important tool in learning, and problem solving can be one of them. Nelson articulates a helpful instructional design in teaching with regards to resolving issues, they:1.

2.

3.

4.

5.

6.

7.

8.

Build readiness.

Determine a preliminary problem definition.

Define and assign roles.

Engage in interactive, collaborative problem-solving process.

Finalise a solution to the project.

Synthesise and reflect.

Assess products and process.

Provide closure.

This design will prove to be an extremely valuable tool to implement for any work issue, particularly in counselling, mediation process, and overall dealing with bullying practices.

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10.6 Learning Cycle; of Star Legacy (Schwartz et al. 1999) cited in Merrill (2002)

Phases for Effective Instruction Merrill (2002)

Role-play is an instructional strategy that utilises previous experiences to provide an experiential learning opportunity and encourage reflection. It is a great tool to use for adult learners. Role-play serves as a learning platform where adult educational theorists suggest better facilitation for the adult learner. It also takes the student to another level in terms of observing actual incidents demonstrated and facilitates discussion of feelings and emotions.

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10.7 Strengths of role play

Key Features of Role Play Taken from the website Roleplayasaninstructionalmethodforadultlearners.weebly.com Role-playing can be used as an effective learning tool to manage the bully in the workplace. An enactment can differentiate or highlight inappropriate workplace behaviour such as bullying harassment and toxic work environment.

Learners gain knowledge of the benefits of experiential and active learning. More than that, role-play assists the adult learner to ground behaviours and tactics, that will be an advantage when adversity strikes in the workplace. It is not about rearranging the deck chairs on the Titanic but eliminating the “iceberg� into which the great ship crashed.

Introducing role-play as a learning tool can have the same advantage as being aware of swimming with sharks. The knowledge and awareness of emotions gained through role-play can be of great benefit to the victim of bullying.

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Learners will profit by acquiring knowledge through experiential, active, and interactive learning. It is suggested that learners participate in a large group, initiate discussion, and identify behaviours as they learn what bullying, harassment, and toxic work environments are and how they affect both the individual and the work environment.

It is suggested to initially show the participants a video on bullying. This sets the mood for the enactment. It will also stir emotions and bring out the values and feelings of the learner, respectively learners will benefit by taking a stance or position on the subject of bullying in the workplace.

The following scenarios are suggestions for role-plays. Teachers and students using individual creativity can create several other scenarios.

10.8 Scenarios to role play •

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Joe is a nurse who has worked in the facility for fifteen years.

He and his wife have recently separated and are filing for divorce. Joe comes to work on the afternoon shift. He notices his co-workers whispering about him. It seems to him that, regardless of what shift he is on, his colleagues are overtly or covertly discussing him. A role-play can trigger discussion of the role of bystanders and Joe’s feelings, considering he is already under stress in the home. The supervisor can discuss the scenario with the class and look at the damage perpetrated towards Joe. Tracy, the nurse manager, gives Brinal a dressing-down at the front desk at handover in the presence of her colleagues 244

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about paper work issues. Role-play, reflect, and discuss how all parties feel (including bystanders). Argue the best response in this instance.

At the end of a staff meeting, Marian tells Pamela in a loud, distinct voice, “I want you to complete that document and have it on my desk by Monday.”

Following each role-play, it is suggested to debrief, reflect, and think critically by considering: 1. How would being the “target/s” in the role-play make you feel?

2. What behaviours do you see as inappropriate?

3. What additional strategies/actions would you suggest to resolve the situation?

Finally, reflect on the emotions the participants experienced.

The role-plays can be performed several ways—in large or small groups. Individuals can be advised to pick a scenario. Alternatively, as an assessment, the group can create a scenario, role-play, and discuss the emotions involved and the response of bystanders, comment on the appropriateness of the conduct, and offer suggestions as to how the incident could have been handled better.

10. 9 Advantages of role play Instructional Strategies Online discusses the purpose of roleplaying. It encourages students to take risk-free positions by acting out characters in hypothetical situations and thereby help them 245

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understand the range of concerns, values, and positions held by other people. Role-playing is an enlightening and interesting way to help students see a problem from another perspective. Interactive instruction, on the other hand, depends on discussion and sharing among participants. Of value is the suggestion that students can learn from both teachers and fellow students to develop social skills and abilities, structure thought patterns, and develop rational arguments.

An interactive instructive approach permits a series of categories and interactive logics. Interactive instruction requires the refinement of observation, listening, interpersonal and intervention skills and abilities by both teacher and students. The success of the program is dependent on the teacher’s ability, the student’s commitment, and overall passion for the subject (Instructional Strategies Online).

The strengths of role-playing have been defined as follows: 1. It facilitates learning across several areas of curriculum content.

2. It involves comparing and contrasting positions on an issue.

3. It demonstrates the practical integration of knowledge, skills, and abilities.

4. It promotes lifelong learning and assists in the application of knowledge to solve problems.

5. It facilitates expression of feelings, attitudes, and emotions.

6. It provides opportunities to speculate on uncertainties and facilitates direct experiential learning while providing feedback.

7. It introduces problems dramatically and provides an opportunity to practice skills Lindsey and Berger (2009) cited in roleplayasaninstrustionalmethodforadultlearners. weebly.com.

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Role-play helps the learner place him or herself in another’s shoes. It should build on the learner’s previous knowledge and experience. It enables people to experience a situation from the past or to prepare for a future situation. It is valuable in learning situations where it is not reasonable to practice the required skills directly in the field. Debriefing and reflection are important aspects for a successful learning situation

10.10 The disadvantages of role-play The authors highlight disadvantages such as:1. It can reveal personal issues with students and thus create a problem with regard to playing the role.

2. Others may overplay and not take the role seriously.

3. Large class groups can cause chaos.

4. Students can become frustrated if the role is too restrictive.

5. Some shy students can be too embarrassed to play the role.

Clearly, the pros of role-play far outweigh the cons. Furthermore, the literature suggests that consideration be given to introducing roleplaying in the classroom as an attempt and a tool to combat bullying. It is an argument worth pursuing. Equip the learner to deal with bullying, and increase awareness of a very real problem in the workplace. The overall long-term benefits achieved would be well worth the time and effort to restructure a teaching module that would encompass bully prevention awareness schemes.

In conclusion, events, scenarios, and main points should be recapped. Staff should be encouraged to specifically discuss bully 247

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conduct that they have witnessed and summarise the strategies examined or learnt roleplayasaninstructionalmethodforadultlearners. weebly.com Confucius said, “I see I forget, I hear I remember, I do I understand.� www.myrkothum.com> inspiration That prophetic word establishes and confirms the argument, that role-play can be an important resolution tool deliver and ground behavior patterns within the adult learner. The aim being to to embed practices that will support employees to manage bullying in the workplace.

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STAND TALL She wants a fight, this crafty shrew.

Her eyes devour your grief and pain.

She talks and throws her weight around, Assert your rights, and fight the good fight.

Do all you can; leave nothing out of sight.

Confront her let her know the hurt she caused, Disrupted your life, degraded you, a situation of memory loss, Giving you little time to even pause.

Hence, stand tall.

Be Fearless.

Seriously, look ahead and quit while the light is still bright, As stumbling in the dark will not help you fight a good fight.

Ingrid Pryde

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CHAPTER ELEVEN

Self-Differentiation and the Problem of Bullying

Introduction Being an authentic adult is hard work and a never-completed task.

The pathway is paved with difficulty and challenge (Smith 2008).

In the course of writing this book, the term “self-differentiation� or a version of the term constantly cropped up in the literature.

An exploration of the meaning of the word resulted in an insight worth revealing. The inherent traits of the victim allow them to fall prey to the bully (as identified in chapter 9). Therefore, a positive transformation can take place if the victim of bullying heeds the advice that follows in this brief chapter, the result is a differentiated person who is confident with a sound self-esteem and content with who he or she is. The advice herein assists the victim to change behaviour and become increasingly aware of self. As this manuscript ends, it is therefore of considerable importance to examine its significance in the construct and relevance within the context of this book.

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11.1 Definition Self-differentiation describes one whose emotional process is ultimately not dependent on anything other than him or herself (Fischer 2010). This is an amazing revelation. Emotions must rely only on one’s self-control to be a self-differentiated person. The well differentiated are those who are able to live and function on their own without undue anxiety or overdependence on others. They are self-sufficient. Their sense of worth is not dependent on external relationships, circumstances, or occurrences (Fischer).

11.2 Challenge Smith (2008) expands on this challenging topic of self-differentiation when he unequivocally states that the person, intentionally and simultaneously, develops increased autonomy and deeper intimacy with self, achieving his or her dreams and ambitions.

Self-differentiation is a progressive, internal situation of autonomy and self-sufficiency, and within that self-sufficiency, we are able to connect with others, progressing towards established and evolving goals (Smith 2008).

On an interpersonal level, “differentiation of self� is the ability to experience intimacy with an independence from others. More differentiated persons are capable of taking a position in relationships, they maintain a clearly defined sense of self and thoughtfully adhere to personal convictions when pressured by others to do otherwise (Bowen, as cited in Skowron and Frielander 1998). It is important to emphasise the value of nurturing relationships. Life is based on interactions. Fractured ones cause enormous stress 252

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whether perpetrator or victim. The main aim should be to live in harmony with each other and it must begin with self. Therefore self-differentiation can create a whole new awareness that is worth exploring; how it is achieved? Is also worth investigating, if the end result is self actualization, then all efforts are worth enduring. Albert Einstein said, “Never give up on what you really want to do. The person with big dreams is more powerful than the one with all the facts.” www.brainquote.com/quotes/authors/a/albert einstein.html Smith draws together qualities of well-differentiated people. He emphasizes and encourages the awareness of self and to feel happy with whom that self is. To differentiate is to provide a platform for maximum growth and personal development for everyone in one’s circle of influence.

11.3 Differentiation is:Smith (2008) describes differentiation as: • • •

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Having the ability to grow to be fully responsible for one’s life Declaring clearly what is needed and being able to request help from others without imposing personal needs upon them Comprehending that an individual is called to be distinct (separate) from others without being distant or cut off from others Knowing there is a responsibility to others but not a responsibility for others Growing in the ability to live in the sane thinking and creative self who can perceive possibilities, chase dreams, and realise 253

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• • • •

ambitions, minus causing unnecessary injury (physiological or psychological) to other people in the process Increasing in the ability to detect where controlling emotions and highly reactive behaviour have directed one’s life and then opting for better and more purposeful growth born of creative thinking Deciding never to use another person for one’s own gain and be honest to one’s self if this pattern begins to develop Visualising one’s life as a whole, a complete unit, and not as compartmentalised, unrelated segments Making no heroes and taking no victims Enjoying the water (rather than trying to turn it into wine) and learning to swim (rather than trying to walk on water) (being realistic in all circumstances)

Differentiated people: •

•

•

Live in their own space and skin without invading the space and skin of others. They maintain individuality and embrace others at the same time and will avoid siding with people even if it appears helpful.

Resist telling others what they need, think, feel, or should do.

They will say “I” rather than “you” or “we” and appreciate differences in people, seeing no person as “all good” or “all bad.”

Are intuitive when it comes to recognising emotional bullying (and all kinds of bullying) and refuse to participate in it. They refuse to be manipulated and hold onto their positions and beliefs without being rigid or defensive.

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•

• •

Remain clear-headed under pressure, manage difficult circumstances without falling apart, and are aware of how much they need others and how much others need them.

Have amazing self-control, will keep their voices down under pressure, and keep clarity to their thoughts and feelings.

Refuse to indulge in spending idle time or energy winning approval, attacking, blaming, or manoeuvring in relationships and will strongly resist playing games with people in order to feel loved or powerful.

Differentiation is difficult. It is not about ordering dry ginger ale because everyone else had requested orange juice or going left while everyone else is going right. The authors do not want the concept misunderstood or trivialised. Differentiation is much more difficult than going against the grain. Any rebel can do that, and rebellion usually requires quite little when it comes to wisdom (Smith 2008).

Differentiation is not first about behaviour. It is an emotional process involving an inward transformation that can lead to new ways of behaving. It is a realisation of one’s uniqueness and seeing one’s role and goals and calling with an internal eye. The inward process proceeds to find outward expression in every aspect of our lives and relationships. It is not a set of rules about how to behave (a little or a lot) differently from others.

Differentiation is not trying to be different, unusual, or controversial for the sake of impact alone. It’s not about making a statement, resisting authority, defying or disrespecting cultural norms, or challenging the values of others.

The process of differentiation might include an appearance of all the above, but it is more than “the road less travelled” or some statement of independence, defiance, or difference. It is a completed 255

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task but an on-going internal condition that monitors oneself in relationships with all others, that is, “Lone Ranger” behaviour, for example, not being part of the crowd and instead being independent and to some extent doing your own thing, with a self-awareness and self-assuredness that might appear “Lone-Ranger-ish” to others.

11.4 Self-Differentiation: A Mediating Factor to Bullying Antecedents Fischer (2010) articulates that people with a poorly differentiated self depend so heavily on the acceptance and approval of others that they quickly adjust what they think, say, and do to please others or dogmatically proclaim what others should be like and pressure them to conform. Bullies depend on approval and acceptance.

More than that, bullies push others to agree with them rather than pushing themselves to agree with others. An extreme rebel is a poorly differentiated person as well, but one who pretends to be self by routinely opposing the positions of others.

11.5 Differentiated person A person with a well-differentiated “self” recognises realistic dependence on others, but he or she can stay calm and sufficiently clearheaded in the face of conflict, criticism, and rejection to distinguish thinking, that is grounded in a careful review of facts and separated from the clouded thinking of swamped sentiments.

Thoughtfully acquired principles help guide, decision making about important family and social issues, the decision maker as 256

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a result is less at the mercy of any subjective emotions that may dominate the moment. What is decided and what is said matches what is done, bringing integrity and validity to the circumstances.

The well-differentiated person can behave selflessly and act in the best interest of the group; will make thoughtful choices and not respond to relationship issues; is a confident thinker; can either support another’s view without being a disciple; or reject another’s view without opposing the differences. The person defines him or herself without being pushy or presenting as superior and deals with pressure to produce an inner strength (Smith 2008).

Self-differentiation is the degree of one’s ability to separate one’s thinking from one’s feelings and to “achieve emotional maturity and independence without losing the capacity to connect emotionally with others” (Charles 2001). People with a poorly differentiated self may be a victim or bully, or they may switch between both roles (Neuman and Baron 2003). Bullies and victims with low levels of self-differentiation have greater instability in relationships than welldifferentiated people. “The self is so poorly developed that use of the pronoun ‘I’ is confined to narcissistic pronouncements such as ‘I want’ (and) ‘I hurt’” (Kerr and Bowen 1988).

Interactions between poorly differentiated people are reciprocal and lack autonomy, for example, the person who gives the most will find someone who takes the most (Charles 2001). They desperately need approval and acceptance of others, poorly differentiated bullies and victims overtly, adapt to what others think, say, or do. This may lead to a phenomenon known as “group think,” in which members must give up autonomous thinking for pathological conformity (Kerr and Bowen, as cited in Haselhuhn 2005). Group think, is prevalent in street gangs and mobbing scenarios. Similarly, workplace bullies impulsively absorb power and control overly passive members and 257

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harass them to comply or suffer consequences (Leymann and Zapf, as cited in Friedman and Murray 2007).

Well-differentiated people can choose to be dependent, interdependent, or independent of the group (Charles 2001; Kerr and Bowen 1988). External pressures do not dictate the well-differentiated person’s thoughts and feelings in the moment. The person is aware of the presence of anxiety in a group situation and is able to manage it, and he or she does not reactively alleviate the unease by giving in or rebelling from the group.

The differentiated person has self-awareness, stays calm when faced with conflict or rejection, and thoughtfully considers decisions.

The person contemplates and balances personal needs together with the needs of the group, is neither a disciple nor bully, and hence is able to withstand pressures to conform to an organisational culture or social climate that supports bullying.

Differentiated persons are aware of their individual triggers to feel victimised or to bully others and can decide against them.

Self-differentiation is not an “all or nothing� concept. Kerr and Bowen (1988) note that individual and group differentiation is on a continuum, and the wellbeing of the group depends on the level of differentiation of its members and leaders. Furthermore, if a significant proportion of group members demonstrate qualities of self-differentiation, it may be within their nature to unite for the protection of weaker members, serve as role models, or set a podium informing the bully that there is strong support for victims in the workplace, which then creates an environment in which it is difficult for bullying to occur.

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11.6 Conclusion A remarkable revelation by Smith (2008) is that becoming a selfdifferentiated person is a difficult task. However, every quality discussed here is, in its entirety, worth pursuing and will assist the reader to reach self-actualisation. It is hoped that the reader will be inspired to achieve self-differentiation and thus be empowered to set up a platform and stand tall, not in arrogance but in acceptance of oneself to be an individual and not a conformist; to view the landscape of bullying as a challenge; to eradicate through an inner strength that can withstand all outside pressures; to not simply be a bystander but to be an active participant who encourages mutual respect, morals, values, and the desire to treat each other as human beings.

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C H A P T E R T W E LV E

Teresa Fights Back

Teresa’s plight for justice ended in the termination of her employment, suicide attempts, travelling overseas to start a new phase in her career, and the near demise of her marriage. She soon realised that, to survive in a dog-eat-dog world, she must have some strategies in place to protect her from difficulties similar to those she had already experienced. As fate would have it, the abrupt end to her employment in Saudi Arabia placed her in the dilemma of deciding what her next move would be.

Following the joy surrounding the success of her daughter’s wedding, Teresa was prompted to self-evaluate her own life and, to ultimately, take a 360-degree turn with regard to her career. One major transformation was inevitable. She would not put herself in the same position as before by returning to full-time employment.

She believed that, to preserve her sanity and wellbeing, she must do short-term contracts and endeavour to not allow herself to be violated and bullied again. The thought of being in one long-term position repulsed her. Therefore, she decided to head in a different direction.

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After discussing her plan with her husband, she decided she would travel Australia to do short-term contracts or work casual shifts until she reached the age of retirement or saved enough money to pay a large sum off the mortgage, as well as the small loans that the couple was carrying.

Her first role was in a small country hospital. She would be in charge on every shift and work mainly with enrolled nurses and assistant nurses. She met one kind nurse from her past, and this gave her a sense of belonging in the small country town. With her husband by her side, she worked hard. She enjoyed his company and having breakfasts out. She was also happy to be nursing in Australia once more, although she still felt fragile and nervous. A small country hospital was the ideal place for a new start, as it was not overwhelming. She was suspicious of her fellow workers and struggled to be assertive, something she knew she had to be—even with the enrolled nurses. Most staff liked her, and they gave her a fancy farewell when she left after three months.

She knew she would not receive the same reception when she moved to a busy intensive care unit in Central Australia. Her clinical skills were a bit rusty due to a lack of opportunities to practice them in her previous roles; however, she realised she must throw herself into the position and update her skills. Technology and science stood still for nobody; hence, the transition and its associated learning curve became a challenge. She would work in ICU, signing up for short term contracts, and repeat the scenario within the same facility, or move to another. Her husband was by her side and working in a teaching role. Her two younger children (adults now) remained in the family home in Sydney. Life had some normality.

Feeling confident in her role, she once again found herself in the position of having to confront a bully. Teresa was surprised and 262

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delighted at her assertiveness in challenging unfair practices. She was also surprised that certain staff members valued her honesty. Quite often, she said what many others were thinking but were reluctant to say aloud. Because she was respected for the standard of nursing care she delivered, people listened to her. She was also fortunate that the manager was a good and fair leader. On one occasion, Teresa reported an incident to the manager. The team leader had not given all the staff lunch breaks, was standing around and chatting while some of the staff (one of them a new recruit) were literally running all morning.

Furthermore unfair patient allocation was common practice for him, and Teresa unfortunately became victim of this bigoted behavior; a frequent practice of his, also clearly demonstrated a bias against her.

The manager confronted the team leader and, in a very calm manner, clarified the situation and professionally arbitrated the conflict.

While her relationship with that particular team leader remained prickly, Teresa began to trigger some awareness of fair rosters, patient allocation, and the fact that meal breaks are a vital part of working an eight- or twelve-hour shift, especially in a busy unit.

It is easy to feel despondent and see the workforce as a mighty power in which to contend. A plea for fairness and mutual respect can be like a cry in the wilderness. However, when one takes a stand against unfair practices and, as a result, experiences change, the satisfaction resulting from the involvement becomes very encouraging. Bystanders, take heed. All humans are obligated to make the world a better place in which to live and work. What makes the task easier is having supportive and competent leaders.

On the home front, Teresa’s eldest daughter, Vivien, continues to build strength upon strength in her role as manager of a department in a recruitment company. More recently she was offered an associate director’s position at the Melbourne branch of the company. She is in 263

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the process of completing a degree in business and volunteers to care for two autistic siblings on a regular basis. Twelve months ago, she celebrated her thirtieth birthday, and Teresa attended celebrations in “rustic Melbourne,” doing the restaurant scene and ending the night in a club. Her children were thrilled to have her accompany them on the dance floor and became very protective when one older male continuously requested her to dance.

Her newly wedded daughter, Tina, is blossoming in her marriage and her role as a product manager for a pharmaceutical company, and recently increased her portfolio by taking on another pharmacy brand to manage. Gaining her the Promotion senior brand manager.

Because she lives in Sydney, Teresa enjoys getting together and discussing current issues. Teresa is very proud of the fact that her two older girls are extremely successful in the corporate world. Needless to say they work extremely hard.

Her third daughter, twenty-five, had been having a difficult time, as she was in an unhappy relationship. At least that’s how it seemed.

She had not confided in Teresa. It was just a feeling a mother gets.

To Teresa’s dismay, the couple was contemplating marriage. Teresa knew it was not the best decision; however, she sensed that, if she intervened, it might drive her dear daughter farther away. She had a heavy heart for her Rachel when she realised at Tina’s wedding that Rachel could be the next one walking down the aisle.

In desperation, she turned to prayer, requesting a change in her daughter’s relationship with her partner. Her request was this, if it was indeed the right relationship, then let it continue. In December 2011, the same year her daughter married and three weeks before Christmas, Rachel’s Facebook status was updated from “in a relationship” to “single.” This was Teresa’s best Christmas present ever!

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Rachel went on to meet someone new, and she is now in a very happy relationship. She has begun study in animal psychology and nutrition, and she has been obtaining distinctions for the course, her high grades won her place at the local university, to study Bachelor of Animal and veterinary Bioscience. At the same time, she works for the Royal Society of Protection and Cruelty to Animals (RSPCA), a job that gives her great satisfaction, as she has an amazing love for animals.

Her fourth daughter, Sasha, is in the final semester of her psychology degree; however, she will need to complete further study should she intend to set up practice as a psychologist. Her interest is in travel. She would like to participate in some voluntary work in India and re-evaluate where she wants to head professionally. She understands she will need to get some life experience while travelling or volunteering, especially if her interest lies in counselling.

Meanwhile, Martin Junior, who is nearly twenty-one, is enjoying life working in an administrative role at the local university’s gym, contemplating travel to Europe with school friends in mid 2014.

Teresa is very thankful and proud where her children are at in life, she is convinced that doing the hard yards diligently during those informative years pays off in the end. Teresa’s fervent prayer is that he will one day choose a career and contemplate study.

In the hustle and bustle of today’s world, like many modern families, Teresa’s family is not as close as they were when all the children were young. While Teresa accepts the pressures of this day and age and understands that each adult child has his or her own life, she hoped she would have more communication through emails and phone calls. Having said that, she realises that the world of today is very different and this is something with which she needs to come to terms. More recently, communication has improved with her two 265

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younger children, gradually there has even been an improvement with her two older children as well. Fortunately communication has always been sound with Rachel, her middle child, especially since her relationship status changed. She always enjoys a brief chat on the phone, or comment through Facebook. It is a big transition for a parent to go from dependent children to grownups running their own lives. She feels in some ways her expectations are a bit unrealistic, however she is confident with the upbringing, love and nurturing all children got the end outcome will be a good and satisfying one. Her pride and her joy is her family, her fervent prayer and hope is, that, that is how it will stay.

Overall, family get-togethers are always a “hoot.” Teresa cooks her famous biryani and a yummy meatball curry, which brings family members back for seconds. More recently, board games have become very popular with the family. It is a great feeling to lie in bed and hear the laughter and chatter of all the siblings and partners as they interact with each other well into the early hours of the morning, though it is not a frequent occurrence, as two of her children live in another state (Melbourne). Christmas is one such happy occasion.

This year, 2013, it is Teresa’s turn to have the children over, and she looks forward to the festive season with anticipation and excitement.

In the “wash-up” of the incidents, experiences, and adventures, unfortunately, her relationship with her husband broke down. He was not happy that Teresa had gone to Saudi Arabia, a revelation that was disclosed two years after the situation occurred. Teresa noticed a distinct change at the end of their trip to Europe, which included London, Scotland, Rome, and Italy, as well as a second visit to Paris.

The strain became more apparent after Martin’s mother took ill following a fall. The eighty-nine-year-old did not ever really recover 266

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and, after some harrowing months, was cared for in a nursing home until she passed away eight months later.

The change in their relationship was a rough time, experienced

by Teresa as she also had a cancer scare following her routine medical check ups. The couple grew farther apart. Disagreements were frequent, and Martin’s behaviour was unpleasant, something to which Teresa did not react well. Her husband was not the loving, caring person he had been. She often questioned herself as to how much damage had been done to their relationship because of their mutual separation, at one stage, up to a period of six months.

However, she was hurting and struggling as well and at the same time, facing a minor surgical procedure. After being married for thirty-four years, she found herself having joint discussions about living separate lives and having arguments and long chats about their future as a couple. One main point she learnt was that two wrongs do not make a right and that forgiveness and perseverance is vital in a relationship. She had the intrinsic feeling that they both wanted their marriage to work out. They had a lot to lose; hence, they both decided to stay together give their relationship, the much needed, priority.

Martin, who had a teaching job in Darwin, was extremely happy in his professional role. He loved Northern Australia’s tropical weather and did not want to be anywhere else. Teresa was feeling the effects of unpleasantness in their relationship and deeply missing her siblings, whom she had a great relationship with, her children, and her friends and fondly thought of the general lifestyle she would have in Sydney. However, she was sufficiently realistic to understand that, to be more content, she would have to work on this situation with her husband. Their aim was to go away on breaks, have quality time together, and rekindle the married life they had eighteen months 267

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prior. This was a commitment they would work towards and a marriage they would strive to keep.

The obvious casualties in a conflict are always the ones closest to you. Sometimes loved ones also need time out, as they carry the burden and trauma of the victim they love. However, Teresa frequently found herself bemused at the conflict she now faced, as she and Martin had spent some lovely times in Saudi Arabia. Then there was the magical winter in Paris over Christmas. During that time, the best aspect of Teresa’s life was the relationship with her husband. Despite the separation, togetherness brought with it a mystical joy. Both partners agreed that they would try to work on their relationship and to return it to where it had been. Should it not work out in six months’ time, they would go their separate ways.

They were convinced that they both needed to be happy. If they could not achieve that together, they would need to achieve it while apart.

Teresa also felt deeply concerned for her two younger children, who were between eleven to fourteen and thirteen to sixteen at the time of the bullying experiences. She was well aware of those times when she could not sleep at night. The children would be awake watching TV or studying, their faces clearly showing their distress as they watched their mum walk around in turmoil. The worst was when she had a bad reaction to the sleeping tablets her doctor had prescribed for her. Teresa could barely stand up. She staggered to the fridge and proceeded to consume a block of chocolate; chocolates are not her favourite snack unlike most other people. She felt that both Sasha and Martin Junior had walked that critical road with her, almost every inch of it.

At one point, on her return from Saudi Arabia, she needed to explain to her son the reason she had decided to work overseas while he was in his final year of study. In hindsight, she should have waited; 268

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however; she had been concerned that she was not performing at her optimum in the Sydney workplace. She had also been concerned about her age and her ability to earn money while funds were needed.

She offered her son an apology for any hurt or disruption her actions had caused him. Her son the forgiving type accepted the apology. He wanted to move forward and was pleased his mum was back home in Sydney to stay.

In terms of the future, Teresa was serious about looking for an alternate career. Several years ago, she had applied to do social work.

Her thoughts returned to the possibility of studying sociology. She believed she could still remain in the health field but in a different role. She made some inquiries about a course offered to international students by a California online program and fielded a phone call. She also loved teaching. She thought she might investigate a diploma in adult education and research teaching in universities. Those were certainly two significant options that she could explore in the near future.

Teresa was happy and secure in the knowledge that Martin had a good job; therefore, she was not committed to working full time.

She had no desire to develop work relationships or feel a sense of belonging by acquiring long-term employment. She was convinced she performed well in her role in ICU. Holding a master’s degree gave her a post-graduate allowance in recognition of the extra study she had taken on. Hence, she did not intend to climb the professional ladder. In northern Australia (Darwin), she decided to do casual work in the hospital’s ICU. She would fill in her roster for a month’s work, and the nurse coordinator would return the availability form approving all the shifts she requested. This was the combined benefit resulting from a nursing shortage and possessing skills that were in great demand. She would walk onto a shift and be pleasant to staff 269

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and, as always, to patients, well aware that she could be swimming with sharks.

After reading the literature, Teresa believed she was well equipped to deal with the bully in the workplace. She learnt to confront situations and to express opinions. She was also committed to not being a bystander. Her aim was to develop a strategy to advocate the motion that bullying is not an acceptable practice in the workplace.

She was convinced she would run with that belief (and run with passion). Her pledge was to be devoted towards eradicating bullying.

She was committed to encouraging freedom of speech, integrity, support assertiveness, and to boldly proclaim that bullying is bad practice, it ruins lives, sends emotions into turmoil, causes health problems, creates disharmony, promotes misunderstanding, leads to financial drain, and, the worst, results in deaths. The very thought of death alone is enough reason to advocate and recognise that, as individuals and members of an organisation, a nation, and a planet, human beings must firmly stand together to stamp out bullying in the workplace.

Teresa knew that, given all she’d been through and all the knowledge she’d gained, she would never again be a victim. She believed she was capable of clearly defining what was needed for her wellbeing and sufficiently confident to request help from others, without imposing her personal needs upon them. She was aware of her responsibility to others, however recognized she was not expected to be responsible for others. This affirmation gave her fulfilment, a sense of self-accomplishment.

Through her experiences, reading the literature on the subject of bullying and writing her book, Teresa has grown in her ability to be a sane thinker. She has become the creative self she has always known she could be. Today, she is hopeful that she can perceive possibilities, 270

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chase dreams, and realise ambitions without causing unnecessary physiological or psychological injury to others.

Her aptitude to detect controlling and highly reactive behaviours, which have previously directed her life, has intensified, and she is now capable of being assertive in an effort to opt for a more purposeful growth through creative and positive thinking.

Teresa made a conscious decision to never use another person for her own gain. Despite the fact that she had never done so, she wanted (needed) to be sure that this tactic would not creep into her behaviour. Her objective is to, always have a deep and abiding love for those closest to her, Teresa is confident that this love will only get deeper as her family grows. Looking back on her journey, she now realises that she must strive to establish an inward process and sense of peace through crirical thinking and an open expression of self. Her goal now is to reach a place that will reflect an outward expression of her life, thoughts, and relationships, a place that will give her reconciliation, contentment with the person she is, and the differentiation to be apart without causing conflict or disharmony while enhancing mutual respect, moral courage, self-esteem, and integrity.

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AN ANONYMOUS POEM OF ENCOURAGEMENT UNKNOWN When things go wrong as they often will, When the funds are low and the debts are high And you want to smile, but you have to sigh, When care is pressing you down a bit, Life is queer with its twists and turns, As every one of us sometimes learns, And many a failure turns about When he might have won had he stuck it out; You may succeed with another blow, The silver tint of the clouds of doubt, And you never can tell how close you are, It may be near when it seems so far;

272

“ANGEL�

SARAH MCLACHLAN Spend all your time waiting for that second chance For the break that will make it okay

I need some distraction oh beautiful release Memories seep from my veins Let me be empty and weightless and maybe In the arms of the angels fly away from here From this dark, cold hotel room, and the endlessness that you fear You were pulled from the wreckage of your silent reverie So tired of this straight line, and everywhere you turn And the storm keeps on twisting, you keep on building the lies That you make up for all that you lack

In this sweet madness, oh this glorious sadness That brings me to my knees In the arms of the angels fly away from here From this small, cold hotel room, and the emptiness that you fear

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You were pulled from the wreckage of your silent reverie In the arms of the angels; may you find some comfort here More lyrics. http.//www.lyricsmode.com/lyrics/s/sarah mclaughlin/

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