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Nurses—and the nursing profession as a whole—are dedicated to providing the best care for patients and residents. However, the environment in which nurses work can be highly charged, and emotions may boil over. Incivility in nursing, bullying, and violence are, unfortunately, a reality for many nurses.

Incivility is rude or disrespectful behavior that may or may not have negative intent behind it. Bullying is repeated, unwanted, or harmful actions intended to humiliate, offend or cause distress in the recipient. When a facility has either of these workplace problems, they may bring in a consultant like Dr. Lisa Grod, owner of LWG & Associates, to help them resolve their issues. 

So what does a consultant do to fix the workplace environment at a nursing home? “I usually ask what concerns or issues need to be addressed, what type of change needs to occur, and how far the nursing home is willing to go to resolve their problems,” said Grod. She recently appeared on the LTC Heroes podcast to discuss Change Management Consulting at SNFs.

Make no mistake about it. People like Grod have their work cut out for them. According to the National Library of Medicine,  sixty percent of workplace violence occurs in health care settings, with healthcare employees being 16 times more likely to experience workplace violence. More worryingly, nurses—due to their direct contact with patients and other medical professionals—are three times more likely to be exposed to violence compared to other medical professionals.

That is a major problem, especially when the long term care industry is currently facing a staffing crisis. Incivility in nursing and other acts of aggression—verbal or physical—are unacceptable, whether they are delivered by patients cared for by the nurses or colleagues of the nurses.

Incivility in nursing is largely avoidable.
Incivility in nursing can take a variety of forms of disagreement.

The National Institute of Occupational Safety and Health (NIOSH) notes that there are four types of violence that nurses and nursing homes should be aware of:

  • Criminal intent: Here, the perpetrator has no relationship with the nurse or the long term care facility and is committing a crime in conjunction with violence, e.g., robbery.
  • Customer or client: This tends to be the most common type of violence experienced by nurses. This type of violence occurs most often in emergency rooms, psychiatric treatment settings, waiting rooms, and geriatric settings.
  • Worker-on-worker: This is also referred to as lateral or horizontal violence. This includes bullying in the workplace and is directed at those considered to be of “lower status” in a facility.
  • Personal relationship: Here, the perpetrator has a relationship with the nurse outside of work that spills into the workplace. An example would be the husband of a nurse following them to work and threatening them.

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5 Ways to Stop Bullying In Nursing and Reduce Incivility

Bullying in nursing can result in lower job satisfaction and higher turnover rates. SNFs cannot risk having nurses leave their facilities. The staffing crisis means they will struggle to find replacements for nurses leaving their facility. According to the Department for Professional Employees, adequate and safe nurse staffing is key to improved care for residents and nurse retention, which prevents nurses from being overworked.

Below are five ways nursing homes and other long term care facilities can stop bullying in nursing:

1.   Model Good Behavior to Prevent Bad Behavior

The best way a nursing home can address bad behavior is by clearly defining what constitutes good behavior. This means setting clear expectations for how employees should treat each other and embracing values such as empathy, respect, and honesty. These can then be written down and displayed for all employees to see.

doctors are talking 2021 08 31 17 05 45 utc 3
Bullying in nursing can be prevented by establishing good behavior.

Once this is done, leadership should lead by example, demonstrating acceptable behavior while also identifying and correcting unacceptable practices by nurses. Grod notes that in her experience, “Change is much easier to implement when leadership buys in and participates. It tells me leadership recognizes the issues and is willing to solve them.” 

Lastly, leaders must remember to highlight the nurses with the best workplace attitude. Advisory Board notes that as part of the ways to stop nurse bullying, leadership must not just criticize inappropriate behavior but also praise and highlight good behavior. In these ways, an environment that discourages bullying is created in the nursing home. 

2.   Make It Easier to Report Bullying

Long term care facilities can provide anonymous reporting options to help report any instances of bullying and help keep the victims who come forward safe. This means providing an anonymous hotline and the opportunity for bullied nurses to talk with confidence to HR. By creating an environment of trust where action is taken against bullies, nursing homes can help victims come forward, as they believe they will be heard.

3.   Never Hesitate to Document Abusive Behaviour

Long term care facilities can encourage nurses to maintain copies of any email and text messages they receive from an alleged bully. Additionally, nurses should keep a time-stamped diary of every event regarding the abuser and their behavior. These documents can prove helpful to the nursing home HR when it comes time to confront the bully. Nursing homes should never ignore bullying or harassment claims, as such incidents can harm employees and residents and result in higher turnover.

4.   Establish the Difference Between Constructive Criticism and Bullying

Not every tense or difficult conversation in the workplace qualifies as bullying. SNFs should educate their employees on what constitutes bullying and what does not. For example, constructive feedback from superiors is not bullying. However, when bullying does occur, nurses should be trained to call it out overtly. Examples include not informing team members of important notices or changes and excluding them from social settings within the department.

5.   Show Victims That You Have Their Back

Nursing homes should show support to the nurses that have faced bullying and harassment. Additionally, co-workers can support the victim by physically standing by their bullied co-worker and confronting the abuser. By being supportive, teams can unite against an abuser and show that bullying or similar behavior is unacceptable. 

How to Prevent Assault in Nursing Homes Against Nurses

Similar to bullying, assault in nursing is, unfortunately, not uncommon. According to the National Library of Medicine, assaults against nursing assistants from residents in nursing homes were common, with 59 percent of those polled stating they are assaulted at least once a week. Additionally, 16 percent of nursing assistants reported that they are assaulted daily by a resident in the nursing home.

Sadly, it does not seem that these trends are going away anytime soon. Nursing Answers notes that incivility in nursing is on the rise, with the American Nurses Association (ANA) releasing a statement on this growing problem. The types of incivility in nursing being witnessed currently include:

  • Yelling
  • Rude or obnoxious behavior
  • Badgering
  • Back-stabbing 
  • Withholding important information
  • Sabotaging
  • Tarnishing reputations

To better understand why incivility in nursing is on the rise, it is essential to know its causes. Open Sourced Workplace notes that some of the causes of incivility in nursing workplaces include:

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A graphic of Dr. Cindy Clark’s Continuum of Incivility.

1.    Mismatched team members: When personality mismatch occurs—for instance, some employees are incompetent or lazy and others incredibly disciplined—it creates a breeding ground for incivility.

2.    Low employee morale: When employees do not feel appreciated or are not happy at the job, they exhibit hostility towards others. And this will only increase if they think others are being appreciated while they are being ignored.

3.    Workplace stress: A stressful work environment will result in incivility in nursing. Project failure, looming deadlines, the passing of a resident, and long work hours with no time off are all factors that will increase workplace stress. And increased stress increases the likelihood of incivility in the workplace.

4.    Bad employees: Some employees will have a bad attitude about the job and toward their co-workers. They may not work well with a team or simply act selfishly. Nursing homes must identify such workers and limit their impact accordingly, as their negative attitudes can be contagious and foster incivility in the workplace.

Since we are witnessing a rise in incivility and assault in nursing, nursing homes and nurses need to take certain preventive measures.

Nurses Must Do Their Part to Prevent Incivility at Their Facility

Nurses must be familiar with the systems in place to protect them and their coworkers. Thus, they should: 

  • Familiarize themselves with their facility’s violence prevention programs and policies
  • Attend facility safety training programs
  • Participate in safety and health committees
  • Report any incidences of violence immediately

Additionally, they should remain vigilant and even take precautionary steps. The National Institute for Occupational Safety and Health (NIOSH) recommends that nurses take appropriate measures to protect themselves while working. Below are some ways to do that:

Be aware of patient behavior

Nurses should pay close attention to patient behavior and appearance. If they recognize something concerning, they should inform the appropriate supervisor. Some potential indicators of violence include:

nurse with senior patient in the clinic 2021 09 24 04 28 15 utc
Assault in nursing can be prevented by paying attention to the signs.
  • Shouting
  • Swearing
  • A threatening tone of voice
  • Clenched fist
  • Heavy breathing
  • A fixed stare
  • Throwing of objects
  • Aggressive or threatening posture
  • Indications of intoxication (alcohol or drugs)

Dress for safety

Nurses can help prevent violence by dressing for safety and not leaving themselves vulnerable to the physical aggression of others. Some ideas are:

  • Removing anything that can be used as a weapon against them
  • Tying back long hair to prevent it from being pulled
  • Avoiding earrings and necklaces or bracelets, as they can be pulled
  • Avoiding overly loose clothing—loose clothing can be grabbed—or clothing that is too tight—tight clothing can restrict movement.

Stay closely attuned to their work environment

Being attuned to the work environment means that nurses are aware of the following:

  • Emergency exits and workplace emergency numbers
  • Confusion, noise, and crowding, which can increase stress levels
  • Sensitive situations, like mealtimes, patient transports, and shift changes, which may result in increased disruptive behavior

Listen to their instincts

The “fight or flight” response can be an early instinctive warning of impending danger. Additionally, nurses should be aware of how they respond and express themselves to others, as this can influence how others react to them.

Tackling Incivility in Nursing Head On

As of 2021, there is no federal legislation that requires workplace violence protections. However, Nursing World notes that several states have enacted legislation or regulation to protect nurses and other long term care workers. Still, for now, nurses and nursing homes will need to take preventive measures to reduce incivility in nursing and prevent assault in nursing. 

Leaders must be active in supporting victims of abuse, making it easy to report acts of bullying, and training nurses to be aware of appropriate and inappropriate behavior. In Grod’s estimation, change in facilities begins with leadership. “It’s about role modeling. A good administrator has to lead by example, and nurses and other staff will follow their actions.” 

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast.

Elijah Oling Wanga