Bullying behaviors among nurses are finally gaining the notice of health care leaders who increasingly struggle to control high operating expenses...which can result from bullying behaviors.Bullying behaviors among nurses are finally gaining the notice of health care leaders who increasingly struggle to control high operating expenses, such as the rising costs of absenteeism, staff replacement, employee benefits, mediation, and arbitration, which can result from bullying behaviors. Leymann, already in 1990, suggested that when managers step in to address the bullying, they may have the tendency “to take over the prejudices of the victim’s workmates…and those around regularly assume that the cause of the problem lies in the deviant personality of the victim” (p. 121-122). Others have described how the victims (targets) of bullying frequently become distressed when defending allegations made about them by the bully who publically describes them as inept, unsuitable, deficient in knowledge, and/or lacking ability (Hutchinson, et al. 2010; Rocker, 2008; Warren, 2011).

In these cases, the initial issue of bullying may become overshadowed by the negative descriptions the bully uses to talk about the victim. The bully may describe the victim as incompetent, lazy, or not a fit for the workplace. Skilled bullies usually have no difficulty seeking out support from others when describing the incompetence of their victim (Hutchinson, 2009; Rocker, 2008; Vickers, 2011).

...the initial issue of bullying may become overshadowed by the negative descriptions the bully uses to talk about the victim.The composite case study described below (developed based on my various leadership experiences in addressing bullying) illustrates the negative outcome that can occur when a frontline manager focuses on the character flaws of the victim (target) rather than on listening to the victim’s present fears and concerns. In this article, which represents a Canadian perspective, I will begin by describing workplace bullying and reviewing the workplace bullying literature. Next, I will present and discuss a composite case study of bullying. To assist managers, I will share helpful supports for addressing bullying, specifically workplace policies, collective agreements, human resources departments, mediation, alternative dispute resolution, and arbitration. What is distinctive to Canada is the official acts that legally require the employer to protect the mental and physical health of employees from bullying and harassment (Occupational Health and Safety Council of Ontario, 2010). The frontline managers’ actions towards bullying behaviors must be consistent with the legislative amendments made by the Canadian government to provincial occupational health and safety acts.

Defining Characteristics of Bullying Behaviors

Malign bullying implies that the bully consciously seeks to harm another while... repeating and enjoying the behavior. Bullying behaviors are either malign behaviors or nonmalign behaviors (Durniat, 2010; Rigby, 1996). Malign bullying implies that the bully consciously seeks to harm another while at the same time repeating and enjoying the behavior (Durniat, 2010). A malign bully has a desire to hurt and regularly directs the behavior from a more powerful group to a less powerful individual (Farrington, 1993). Malign bullying often includes slander in which an untruth that will harm the reputation of the individual being bullied is told.

 Nonmalign bullying (mindless and educational bullying) is unintentional yet also hurtful to another. In mindless bullying, the person is unaware that his or her behavior is harmful, and is not hateful or cruel toward others. It involves criticizing and engaging in an insensitive exposure of a person’s limitations leading them to believe that they are inferior. Educational bullying is a practice whereby someone possessing knowledge, for example a nurse educator, may deliberately withhold information or make the individual feel inadequate, clumsy, or foolish in front of others when he or she cannot answer a question.

Nonmalign bullying is unintentional...[and] involves criticizing and engaging in an insensitive exposure of a person’s limitations... As part of this discussion, it becomes important for frontline managers to separate bullying from incivility. Bullying should not be confused with workplace incivility. Incivility manifests in disrespect, rudeness, and general disdain for others; for example, rolling of the eyes (Luparell, 2011). Although one may behave with incivility towards another person, it does not mean that they are displaying bullying behaviors. Incivility implies lack of politeness, offensive comments, and rudeness. Increased workload and organizational change have the potential to increase employees’ anger and stress causing them to express uncivil behaviors towards others, sometimes in the form of withholding information and knowledge (Shim, 2010).

In contrast, bullying suggests inappropriate, unwanted, vexatious, and hostile behaviors toward others (Luparell, 2011). For example, bullying behaviors include interactions in the workplace, such as using hand gestures to ward off conversation and/or reviewing documentation of others for the purpose of finding and reporting errors (Anastasius, 2010).

Review of the Literature

In the 1980s, the Swedish psychologist, Heinz Leymann, pioneered the study of workplace bullying. The work of Leymann became a benchmark worldwide for treating the oppressed and traumatized worker (Leymann, 1990, 1996). Sweden became the first country in the world to establish an ordinance against victimization at work. Victimization has been described as “recurrent reprehensible or distinctly negative actions which are directed against individual employees in an offensive manner and can result in those employees being placed outside the workplace community” (Namie & Namie, 2009, p. 260).

Frequency and duration of bullying are apt to make the target person powerless because bullying drains the target of his or her coping resources. Georgio (2009) has suggested using an interactionist perspective, looking at interactions between the person and the environment, to explain bullying. Georgio observed that bullying behaviors generally occur over a six-month period in which people are exposed to negative behaviors affecting their work tasks. Frequency and duration of bullying are apt to make the target person powerless because bullying drains the target of his or her coping resources (Leymann, 1996). The imbalance of power makes it impossible for the target to retaliate or effectively protect him or herself (Einarsen, Hoel, & Notelaers, 2009).

Leymann (1996) proposed that organizational factors and leadership problems caused bullying. In contrast, Hoel and Einarsen (2010) suggested that these leadership problems themselves do not harass. Rather the true cause of bullying may lie in the social group, in that bullying is more likely to happen in a social group because the victim experiences and suffers from social exclusion (King-Jones, 2011; Schuster, 1996).

Nurses who bully may have high levels of self-interest, a need for power, personal problems, and/or psychological difficulties.Katrinli, Atabay, Gunay, and Cangarli (2010) did find, however, that horizontal bullying among nurses may be deliberate, resulting from organizational structures and politics. Deliberate, horizontal bullying might be a rational strategy used by perpetrators completing for promotion, preferred assignments, high performance appraisals, allocation of resources, and recruitment. For example, if the organization has an individual, performance-based, reward system, employees may complete for a top position by bullying each other. Nurses who bully may have high levels of self-interest, a need for power, personal problems, and/or psychological difficulties.

Rocker (2008) and Anastasius (2010) have suggested that the nurse manager should provide structural support for nurses on the nursing unit by changing the unit rules, unit behaviors, and establishing a blame-free culture. For example, incident reporting should focus on system factors that cause errors; it should not be used as a bullying tool for ‘writing–up’ nurses for social control or dishonoring them.

In 2000, the Canadian government amended the Canada Labor Code Regulations necessitating that employers take specific steps to protect employees against and to stop violence in the workplace (Human Resources and Skills Development Canada, 2011). As of 2011, bullying is illegal in two provinces (Saskatchewan and Quebec) and the remaining provinces address workplace bullying through provincial Occupational Health and Safety Acts (Human Resources and Skills Development Canada, 2011; Province of Saskatchewan, 2007). Yet bullying remains rampant in the workplace and victims often find themselves in vulnerable situations in which a power imbalance exists between them and the frontline manager. The following composite case study exemplifies this imbalance and demonstrates the undesired consequences of bullying.

Composite Case Study

...the actions of the bullying often share a common theme, namely triangulation. Over my many years as a nurse manager, educator, and staff nurse, I have observed various types of bullying behaviors among nurses. Although each case of bullying is unique to the target, the actions of the bullying often share a common theme, namely triangulation. Canadian nurse Betty (not her real name) and her friend both present a typical example of triangulation, in which a bully gives minimal information to the manager suggesting the manager might want to investigate the nurse’s (target’s) debatable practices. Triangulation is used to cause unit unrest by freezing someone out of the unit, preventing another’s advancement, and/or challenging the frontline manager’s leadership abilities (Katrinli, et al., 2010; Szutenbach, 2008). A typical example of triangulation might occur when a nurse bully suggests to the frontline manager that she is concerned that an advanced practitioner, new staff member, or someone with higher education may not grasp a concept or ‘get it.’ The bully never defines ‘not getting it’ but merely plants the seed in the mind of the manager that something is wrong and should be investigated—an investigation that may take on the additional prejudices of the victim’s co-workers(s). The following composite case study exemplifies how this could occur.

Triangulation is used to cause unit unrest by freezing someone out of the unit, preventing another’s advancement, and/or challenging the frontline manager’s leadership abilities. Betty, a nurse with a postgraduate degree, working day-evening casual shifts, shared with the charge nurse that she has been bullied by a physician. She explained that the physician had thrown equipment across the room, grabbed equipment out of her hands, and told her that “in no circumstances would he look after her if she were injured.” Each of these behaviors occurred front of patients. Betty felt embarrassed, and was in disbelief by the actions of the physician. She told the charge nurse about the incident requesting that the charge nurse keep the conversation confidential. Unknown to Betty, the charge nurse reported the matter to the nurse manager.

Without explanation, Betty was summoned (on her day off) to report to the manager’s office. After the nurse manager discussed the bullying incident, he assured her that the nursing unit had never experienced any types of bullying behaviors in the past between a physician and nurse. In fact, his position was that of zero tolerance for bullying behaviors. He encouraged her to report the incident.

Not wanting to draw attention to the incident for fear of reprisal, Betty declined his invitation to report the incident. The nurse manager did not take any further action with Betty, and the incident was never again discussed with her. The following day, however, a co-worker informed Betty that after her meeting with the manager he immediately made rounds on the nursing unit asking if anyone had any concerns with this physician. One staff member did report seeing the physician bullying two other nurses during a procedure. Again, the manager did not follow up, for example, by reviewing respectful workplace policy.

Once the incident was known throughout the nursing unit (via the grapevine), Betty believed that she was being re-victimized by the charge nurse. The charge nurse began scrutinizing her documentation, looking for gaps in reporting, and revealing any findings to the frontline manager. Betty also heard the charge nurse, and the staff nurse who had reported the incident with the physician, gossiping at the desk with reference to reporting her practice. As she approached the desk, they become silent and turned away.

The next day the nurse manager summoned Betty to his office (during her time off), refusing to provide any rational for this summons. The nurse manager informed her that the charge nurse believed that her charting lacked evidence of critical thinking (a subject that Betty has studied for years). Betty became very disheartened by the lack of managerial support in her practice.

Later, Betty experienced fear and vulnerability when she was asked to meet with the nurse manager without explanation. She remembered her friend, a registered nurse (RN) with six years of experience, sharing her personal experience with bullying while working with a registered practical nurse (RPN). According to her friend, the RPN ‘took exception’ when she offered her advice on solving practice issues. The relationship between the two nurses became so strained that the RPN stopped communicating and Betty’s friend found herself in tears. In hopes of re-establishing communication with the RPN, Betty’s friend sought out guidance from her nurse manager. She shared with the nurse manager the RPN’s behaviors: gossiping, stopping conversation with others when she approached, and posting notes about her on Facebook. After sharing her feeling with the nurse manager for the second time, Betty’s friend thanked her manager for listening and asked her to keep the conversation confidential.

Instead of keeping the conversation confidential, the nurse manager confronted the RPN and arranged for mediation between the two parties. Perplexed and ‘feeling defeated’ by the nurse manager not respecting her request for confidentiality, Betty’s friend had sought out support from a union steward. Much to her friend’s surprise the union steward was already aware of the situation.

A mediation time was set and the following people attended: nurse manager, Betty’s friend, union steward, RPN, RPN’s support person, and the mediator. The mediator interviewed both Betty’s friend and the RPN before the meeting, starting with the RPN.  During the meeting, Betty’s friend had felt that the mediator was not listening to her story. The nurse manager contributed nothing to the conversation. The union steward recommended that Betty’s friend not sign the mediation agreement in its present form because it lacked language that was consistent with mediation (a process for resolving disputes, not for disciplining) (Ontario Human Rights Commission, 2011). After rewriting the agreement, Betty’s friend agreed she would work to improve communication, not discuss the incident with others, and attend a follow-up discussion.

After returning to work, however, Betty’s friend continued to hear others gossiping about her and believed that she was experiencing acts of re-victimization. Saddened by the situation, she removed herself from Facebook. Fearful of working in a hostile environment, she quit her job and went to work in another hospital.

Betty, herself, was afraid of being re-victimized at the hands of other nurses hearing her story. She did not want to spend her time off at management meetings re-living, ruminating, and defending accusations made about her by others. She was concerned that these accusations might cause her to develop a stress disorder. Betty left her employment without knowing if the true bully would be identified; the true bully being the staff nurse who reported seeing the physician bullying other nurses, gossiped, and coordinated the actions of others.

Discussion of Composite Case Study

This composite case study illustrates that both nurses left their positions because of the fear of re-victimization. It shows how a hostile work environment in which a bully targeting Betty was capable of orchestrating the nursing staff so as to control, manipulate, and direct the decisions and behaviors of a frontline manager. Betty thought she could not report bullying behaviors if the nurse manager did not even recognize that a bullying problem existed on the nursing unit. Lacking the support of their nurse managers and fearing future victimization, both nurses left their positions.

...many frontline managers who are responsible for resolving conflict in the workplace lack the preparation and education needed to address these issues. Betty and her friend both believed that their nurse managers had betrayed their request for confidentiality and failed to provide a respectful work environment even thought, according to the Ontario Human Rights Commission (2011), every employer has an “obligation to provide employees” (p. 1) with a healthy working environment that addresses and prevents harassment. However, many frontline managers who are responsible for resolving conflict in the workplace lack the preparation and education needed to address these issues.

Supports for Addressing Bullying

When nurse managers are confronted with reports of bullying, it is important that they listen to the staff member’s story to assess the situation thoroughly and seek to determine whether a problem of bulling exists (Creswell, 2005). After establishing the validity of reported bullying, including either malign or nonmalign bullying, frontline managers should meet with the concerned employee. Employees need to be informed of their legal right to have union representation (steward) or other representation at the meeting (British Columbia Nurses Union [BCNU], 2011; Saskatchewan Union of Nurses [SUN], 2011; United Nurses of Alberta [UNA], 2011).

After establishing the validity of reported bullying, including either malign or nonmalign bullying, frontline managers should meet with the concerned employee. As of 2012, the Canadian Federation of Nurses Unions (CFNU), represents and gives voice to 156,000 nurses and student nurses (CFNU, 2012). As a national voice, the CFNU makes the Prime Minister, Minister of Health, and members of parliament aware of nursing perspectives and positions related to policy making. At provincial levels, each province has its own nursing union. For example, the Manitoba Nurses Union (MNU) is an organization dedicated to ensuring that members’ voices and grievances are heard, and that agreements are negotiated for salaries, benefits, and working conditions (MNU, 2012). At the national level in the United States (US), the American Nurses Association makes members of the U.S. Congress and other relevant bodies aware of nursing perspectives and positions related to policy making. Individual states have their individual nursing associations that have varying levels of union involvement.

According to the Canadian Center for Occupational Health and Safety (CCOHS), a non-union employee may seek council from an Employee Assistance Program (EAP), a service often purchased by the employer to manage difficult situations (CCOHS, 2009). A victim of bullying may also obtain support and advice from a physician, psychologist, or lawyer, and may gain access to sick leave, workers’ compensation, or employment insurance. The frontline managers may seek information and problem-solving strategies from their immediate supervisor(s) and/or the resources described below, namely workplace policy, collective agreements, and human resources management departments, as well as mediation, alternative dispute resolution, and arbitration tools.

Workplace Policy

Canadian workplace safety regulations are determined by the federal government and administered by provincial Occupational Health and Safety Acts (Canadian Initiative on Workplace Violence, 2007). In 2011, the province of Manitoba amended its safety act and passed Bill 219—The Workplace Safety and Health Amendment Act (Harassment and Violence in the Workplace) (Legislative Assembly of Manitoba, 2011). Harassment was defined as “behavior of a person, either by repeated conduct, comments, displays, actions or gestures, or by a single serious comment, display, action, gesture or occurrence of conduct, that is:

1. unwelcome, vexatious, hostile, inappropriate or unwanted,
2. based on race, creed, religion, skin color, sexual orientation, marital status, family status, disability, physical size or weight, age, nationality, ancestry or place of origin, or
3. an improper use of the power or authority inherent in the person's position” (p. 1).

The act requires employers to both develop policies that investigate allegations of workplace harassment and violence and start violence prevention programs; it gives the worker the right to refuse to work in some situations.

In 2010, Ontario introduced Bill 168 to address workplace harassment (Occupational Health & Safety Council of Ontario [OHSCO], 2010), considering workplace harassment to be "engaging in a course of vexatious comment or conduct against a worker in a workplace that is known or ought reasonably to be known to be unwelcome" (p. 26). In addition, Bill 168 requires the employer to develop written policies, expand and maintain programs that implement policies, and review these policies at least once a year.

According to the OHSCO (2010) developers of workplace harassment policy and programs must know their legal rights in relations to the Occupational Health and Safety Act, Ontario Human Rights Code, and workplace collective agreements. The OHSCO has noted that policy development begins with gathering information from workers, current policies, and programs, and that the policy “should include a high-level statement on the commitment of senior management to protecting workers, investigating incidents, and dealing with incidents” (p. 1). Measures and procedures for reporting and investigating the incident should:

• Include how to report the incident
• Include how the employer will investigate and deal with the incidents
• Include how to report harassment originating with the manager
• Establish trainers (workers and supervisors), and
• Consider supplementary training—workplace harassment awareness, prevention, or provincial (Ontario) human rights issues.

Collective Agreements

Either the target or the bully may ask the union for assistance in resolving conflicts such as bullying (UNA, 2011; SUN; 2011). Therefore, it becomes imperative that frontline managers become very familiar with their workplace collective agreements. Collective agreements are established at the provincial level and address the terms and conditions of a nurse’s employment (UNA, 2011). According to the United Nurses of Alberta (UNA) a dispute between nurses is an unlikely topic for alleging and violating the collective agreement; instead disputes usually affect employer and employee relationships (UNA, 2011).When considering a complaint of bullying against another employee, the union’s labor relations officer and local grievance committee give advice to the employee regarding the grievance process. The grievance process includes:

• An attempt to dialogue with the immediate manager to settle the dispute
• (If unresolved) a submission of the grievance to the Director of the Department with the expectation that the director will respond within a stated time frame (usually 10 days)
• (If unresolved) a submission of the grievance to the administrator to resolve within a declared duration of time
• (If unresolved) a submission of the grievance to a mediator (however, the mediator’s decisions are not necessary binding), and  
• (If the decision of mediator is unacceptable) a submission of the grievance to an arbitrator who awards a final and binding decision for both parties to follow.

Human Resources Management

Vancouver Island Health Authority's (VIHA's) Respectful Workplace People and Organizational Development strives to provide a workplace in which employees are treated with respect and dignity, without discrimination or harassment, and are supported in managing workplace differences (VIHA, 2009). The frontline manager may seek support from a Respectful Workplace Specialist to achieve resolution of the complaint. The Respectful Workplace Specialist is someone who offers human rights education, assistance, and advice. For example, the Respectful Workplace Specialist may provide confidential advice and coaching to frontline managers regarding harassment issues, ease group interventions, complete an initial assessment, and/or act as a case manager for formal complaints. The Executive Director of the Respectful Workplace People and Organizational Development decides time limits for filing a formal complaint and approves an investigator or mediator for formal complaints.

In union environments, disputes may also be solved using informal or formal resolution processes (VIHA, 2009). The informal resolution process involves speaking directly with the individual, whereas the formal resolution process involves a formal complaint, an investigation process, remedies, closure, and follow up. In those parts of Canada where unions do not exist, standard employment legislation and human rights legislation is followed (Government of Canada, 2011). In these non-union environments, conflict resolution may be overseen by a lawyer, psychologist, self-help group, conciliator, mediator, or arbitrator.

Mediation

Mediation is a process for resolving disputes between two or more persons in private and without going to court (Government of British Columbia, 2011). The trained mediator has no discussion-making power; instead, the mediator helps people settle a conflict by separating the person from the problem. Mediation can occur if both parties are willing to meet together and neither party ignores the problem. Mediation also addresses impasses in which complex cases require creative solutions; both parties want to maintain a future relationship; and a need exists to resolve behavior issues. Mediation does not work in situations in which there is unwillingness on the part of one or both of the parties to compromise, or when there is fear of violence, or to challenge or change a law.

Alternative Dispute Resolution

Alternative Dispute Resolution (ADR) is a voluntary process that helps two or more persons in reaching a resolution (Government of Canada, 2011). The process is confidential and involves a neutral third party. ADR can offer the advantage of reducing drawn-out and costly litigation. ADR is also less confrontational than mediation and arbitration and can help individuals maintain a working relationship. The disadvantage of ADR is that the neutral third party cannot issue orders requiring parties to change their behaviors.

Arbitration

Arbitration is the oldest form of dispute resolution. According to Saskatchewan Union of Nurses (2011), either the union or employer may notify (in writing) the other party of a desire to revolve a difference using arbitration. Time limits are placed on the procedural steps of the arbitration so as to maintain procedural orderliness. If the employer and union do not appoint a chairperson to the Arbitration Board, the Minister of Labor makes the appointment. The Arbitration Board hears the differences and renders a decision; however, the board cannot substitute, alter, or amend the provisions in the collective agreement. In a non-union environment, an arbitrator may be hired by contacting the local courthouse; however, both parties must agree to the arbitrator.

Conclusion

Simons and Mawn (2010) have described the economic consequences for organizations when nurses leave their jobs because of workplace harassment, incivility, and/or bullying. These economic costs include the considerable costs of recruiting, hiring, and orienting new employees. The composite case study presented above illustrates that nurses do recognize bullying behaviors, yet often believe they are powerless to change these behaviors.

It is important that frontline managers take nurses’ complaints seriously, act on them promptly, and use appropriate resources to resolve the conflict situation... It is important that frontline managers take nurses’ complaints seriously, act on them promptly, and use appropriate resources to resolve the conflict situation according to organizational anti-bullying, respect-promoting workplace and harassment policies. Frontline managers also need to recognize that nurses may be unprepared to participate in any form(s) of resolution because of perceived power imbalances between the nurse and the manager and/or the fear of re-victimization. It is essential for frontline managers to understand the fears of further victimization that are often held by victims of bullying, and to work to shift the focus from the victim to the bully, as they work to achieve conflict resolution and maintain a respectful work environment.

Author

Carol F. Rocker, PhD, RN
E-mail: carolrocker@shaw.ca

Dr. C. Rocker has a Doctor of Health Administration from the University of Phoenix (AZ). Her dissertation work is focusing on healthy work environments for health care workers. She has previously held positions in nursing management and nursing education. Dr. Rocker holds a Bachelor of Nursing degree and a Masters in Health Care Administration degree from Athabasca University, Athabasca, Alberta, Canada She has published in peer review journals and lectured internationally on the topic of bullying among nurses.