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Creating Healthy Work Environments 2019

Check out these articles written by presenters at the 2019 Creating Healthy Work Environments conference.

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Together, we can create cultures free of psychological violence

Debra C. Hampton |

It takes a team to deal with bullying.

Together, we can create cultures free of psychological violence

The author discusses psychological violence in the workplace and identifies options for dealing with it. When nurses are empowered, it helps them and other team members cope.

Together, we can create cultures free of psychological violenceWhen I think about people I have worked with or reported to, excellent leaders come to mind. They were honest, caring, trustworthy, visionary, and inspiring. They took time to make sure everyone on the team felt valued, supported, and included, and they made creating a positive workplace culture an important part of their job.

One such leader is my current boss, who walks the talk and leads the way with vision, honesty, consideration, and caring. Showing co-workers that you care can work miracles in improving teamwork and productivity. Great leaders understand they cannot succeed alone but can achieve greatness when they work together with a committed team. Negativity and disrespect are not part of the management style of authentic, transformational leaders.

Unfortunately, my memories of good bosses are sometimes overshadowed by thoughts of leaders I’ve worked with who have been bullies. The first bully who stands out in my mind was a colleague. At the time, I didn’t realize that this nurse’s behavior was bullying. Now, I do. As other nurse leaders report from personal experience, bullying and psychological violence are, sadly, part of some leaders’ management style.

The literature is filled with articles about the high incidence of bullying and horizontal—or lateral—violence in frontline nurse settings. But less information has been published about nurse leaders who are victims of bullies and the negative consequences that result. According to the American Nurses Association, bullying involves intentional behaviors meant to undermine, cause humiliation and distress, and control the victim. A recent study reported that 60 percent of nursing leaders are bullied at some point in their careers. Horizontal violence and bullying are sometimes used interchangeably. But, to me, bullying implies a more deliberate level of psychological violence.

The physical, psychological, and organizational effects of bullying are well-documented. It can have a negative impact on energy level and hinder the ability of individuals to deal with the challenges of today’s healthcare environment (Hampton & Rayens, in press). Drexler observes that the Queen Bee Syndrome may contribute to the high incidence of nurse-related bullying. Female nurses may bully other female nurses in the work environment, she writes, because they perceive them as competition and thus are motivated to degrade their self-confidence and professional reputation. But one does not have to read the literature to recognize the harm that bullies inflict on their victims.

Dealing with workplace negativity
Teamwork and ongoing effort are necessary when dealing with bullying, whether from bosses, colleagues, or subordinates. Multiple experts and organizations, including The Joint Commission, offer strategies. The American Association of Critical-Care Nurses provides six standards for a healthy work environment: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.

Adding empowerment to the toolkit helps team members cope with psychological violence in the workplace (Hampton & Rayens, in press). As my colleagues and I have reported, nurse leaders across the United States suggest the following as possible solutions: confrontation; crucial conversations; avoidance; self-care; and help from within the organization, including human resources. I address these options below and point out when they may or may not be effective.

Some leaders suggest the best strategy for dealing with psychological violence is to confront bullies, inform them they are bullies, and tell them their behavior is not acceptable. Sometimes this strategy is effective, but when bullying is intentional, confrontation may not help. In fact, it may make matters worse.

Overall, the most effective way to deal with conflict is to have an open conversation with the instigator. This strategy may work effectively when bullies don’t realize their behavior has become inappropriate. But, having a straightforward conversation with deliberate bullies may not be the answer.

This is generally not the best way to deal with conflict because, if the situation isn’t addressed, it is likely to continue. However, because of the discomfort one feels in the presence of a bully, avoidance may sometimes be a wise strategy. If you don’t need a bully’s guidance or input to do your job, your best option may be to avoid him or her.

A wise choice in any stress-producing situation—including when you’re the target of a bully—is to focus on caring for yourself. Nurse leaders suggest the following self-care strategies: 1) Read everything you can on how to deal with bullies and increase resilience; 2) seek support from colleagues and others in your organization; 3) reflect on positive contributions you make to the organization; and 4) maintain a high level of self-worth.

Building a strong support base is a self-care strategy that deserves further mention because of its value when coping with psychological violence. Ask for help from colleagues—including your supervisor, provided the bully isn’t your supervisor. Tell people you trust within the organization about the situation, and listen to their advice. This offers far more benefit than seeking to improve self-esteem and feelings of control. Letting others know they are helping builds relationships and adds to organizational and personal emotional bank accounts. Kok notes that an emotional bank account transcends “time, space, and hierarchy.” Deposits go both ways when you ask a colleague for help. They feel valued, and you feel supported.

Leaving, the last resort
If the bullying is out of control and you are not receiving needed support, your best option may be to leave the organization and find a healthier work environment. This should not be your first option, however. If you’re the victim of a bully, first seek support from human resources or others you trust within the organization.

We often hear, “Don’t underestimate the power of positivity and caring relationships.” It’s important advice for nurse leaders, and nurses at all levels must stand together in making it clear that there is no place in “health” care for bullying—whether by subordinates, colleagues, or bosses.

We must build our psychological capital by identifying best practices for dealing with bullying and continuing to study which strategies work best in specific situations. Florence Nightingale taught us that little can be accomplished when we live under a spirit of fear and that “life is a splendid gift” that should be lived to the fullest.

Walking the talk and leading the way with vision, honesty, consideration, and caring will move nursing forward and provide environments that are healthier and more positive. Together, as nursing leaders, we can improve the healthcare work environment by creating work cultures that do not tolerate psychological violence.

Debra C. Hampton, PhD, MSN, RN, FACHE, NEA-BC, CENP, an assistant professor at the University of Kentucky College of Nursing, Lexington, Kentucky, USA, is academic coordinator of the college’s BSN to DNP Executive Leadership Program and MSN to DNP Leadership Program.

Editor’s note:
Debra Hampton presented Development of Psychological Empowerment Over Time and With Experience in poster and rapid discussion sessions on Friday, 22 February 2019, at Sigma’s Creating Healthy Work Environments conference in New Orleans, Louisiana, USA. On Saturday, 23 February, she presented The Relationship Between Resilience, Intent to Leave, and Bullying of Nurse LeadersSee the Virginia Henderson Global Nursing e-Repository for additional information.

Check out these additional articles by presenters. 

Hampton, D., & Rayens, M. K. (in press). Impact of psychological empowerment on workplace bullying and intent to leave. Journal of Nursing Administration.

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