Family Assessment

Name : Davinder Kaur Narangan Singh

Student Number : S2785524

Course : 3976NRS Contemporary Nursing

Bullying has become one of the most common forms of work place violence and it is identified as the most concerning forms of aggression, especially among nurses. Workplace bullying is a very serious problem in health care and it affects the nursing profession. Bullying among nurses usually happens mostly with the newly graduated nurses, than compared to a nurse with experience ( Lewis, 2006). Bullying among nurses is said to begin during undergraduate or new registered nurse or if not so nurses will definitely be bullied some time later in their work life ( Quine, 2001). Some use the term lateral or horizontal violence to describe the aggression between nurses in the workplace. There are many types of bullying but the most common one which happens in hospitals are lateral violence and horizontal violence. Horizontal violence happens mostly. Why? In this essay, we will discuss about the definition of bullying, some of the factors of bullying that what made bullying a norm in current nursing practice, also discuss its impact on nursing and healthcare, and the recommendation to reduce or prevent the bullying issue in workplace.

Horizontal bullying is a widespread phenomenon in nursing as well as other professions, besides it is recognized as a major problem in hospitals. horizontal violence is injurious behaviour aimed by one worker toward another worker who is of equal status within a hierarchy that seeks to control the person by disregarding and diminishing his or her value as a human being (Blanton, Lybecker, & Spring, 1998). For example like, calling names, using inappropriate words on each other, or doing harmful things.Horizontal violence can also be defined in term of 3 elements, which are for the effect on the recipient rather than the intention of bully, an act which is repeated should have a negative impact which can possibly risk the health or safety of the target and lastly the behavior must be persistent over the time. There are two categories that bullying can be classified, which are, inter-professional and intra-professional. Inter-professional violence happen between a physician and a nurse . On the other hand, intra-professional violence is among nurses itself. It could be an upward or downward hierarchical bullying which may involve a nurse and a nurse manager, or it could be just between the nurses. If it is related to horizontal violence then bullying is intra0professional. Bullying activities can be over or covert behaviors (Cleary et al., 2010). Covert behaviors are usually indirect but also have some negative effects and some of the examples are ignoring someone, refusing to respond to questions or refuse to help and work with the individual, talking rudely and also isolation. Wherelse, overt behaviors are direct, which are yelling at someone, name calling, spreading rumors, being humiliated or ridiculed about ones performance at work and also gossiping.

Horizontal violence is said to be a major problem in the nursing workplace and which the victims are usually nurses itself. This has been increasing because nurses or the victims who are being bullied are not reporting as it is a must for them to voice up to stand for themsleves. What has lead or influenced to the acceptance of bullying in nursing? The theories that we can see from the background or history of nursing. Feminist theory and the theory of oppression ( Freire, 2000). Previously nurses used to be under physicians or any leading group control because they were not allowed to have any control over their autonomy, practice and accountability by the leading group and the physicians has caused nurses to feel powerless and make them weak in the sense of identity. As a result of these factors, nurses’ oppressed personal behaviors tend to convert against their colleagues. Furthermore, Bartholomew discusses that female has considered as the subordinates in the society and nursing staffs were mostly females. Generational abuse is known as ‘nurses eating their young’. This has been happening in the past an in recent time as well. The reason of this could be because they were also once treated badly when they first started their profession as a nurse. Thus, younger nurses might or will for sure experience bullying from nurses of older generation or more experienced. Moreover, unquestioning obedience was another practice form the past by the nurses. This was to be applied or carried on, on new comers, means that nurses who ask questions will not be regarded as trustworthy but the nurse who never questions is very reliable (Hein, 2001). This practice use to be going on in the past but not for now because nurses nowadays have the rights to voice up for any wrong doing, autonomy to nursing practices and all nurses now are also independent. The power of management: poor leadership style, are also a contributing factor to lateral violence from both inter and intra professionals. Rigid hierarchical management style: between supervisor and employees increases the chance of horizontal violence. The lack of good role models in nursing to encourage the newly graduate nurses is one of the advantages of bullies to be happening. Furthermore, hierarchical abuse happens when the supervisor or the senior staff uses bullying as a strategy to get things done.

When a management or organisation do not have certain rules or limitations on bullying issue, this is when an organizational culture issue arises because they had made it as a norm of their daily practice at work. Thus, when the new graduates turns up for sure they would not recognize if they are being bullied or it is their nursing job to do that. For example, many new graduates do not really know what they have to do when they have just started working, they will not know what are their responsibilities and therefore, the experienced nurses tend to have higher chance of bullying them. Healthcare service providers working under pressure , this type of environment has an increased chance of bullying and also short staff environment due to bullying issues. This leads to an economical factor . Education factor: nurses feels low self esteem and are at higher risk of being bullied because as said most of nurses are afraid of the powerful group which are the physicians and managers who have the hierarchy power. With all this contributing factor of bullying, it is impossible to break the cycle but it is important to do it, because of the dreadful impact of bullying.

Horizontal violence can cause negative impact on current nursing practice, In terms of organizational, individual well being, global outcomes and societal.individual that experience bullying can be affected by any kind of physical and psychological consequences, for example headaches, stress, fatigue, post-traumatic stress disorder ( Lewis & Orford, 2005; Ramos, 2006) nurses who are being bullied have the higher rates of abseenteism. Moreover, individuals social role will be affected, higher chance of bringing work stress to home, having trouble with family and social relationship. An individual will also be isolated not only at work but also back home due to lack of self-esteem. These will then result in staff turnover,and decrease morale. Statistics in the study has show that the reported incidence of horizontal violence in hospitals was about 17.6% to 75% (Farrel, 1997). Those who experience bulling would either quit their job or if it is worst then they might also quit their profession. As a result, the organization will have issues such as shortage of staff and due to the poor reputation job seekers would not consider it as a preferred employer. Factors such as lack of staff, poor organization status or high turnover rates will cause difficulties to attract health consumers as well. This will increase extra cost foe the organisation to then have training for the new comers There are very high chance for staff to take leaves due to experiencing horizontal violence at work, therefore, the organization have to compensate the hours lost. When bullying is reported by staff, the healthcare organization have to investigate it, and take immediate action before it happen to someone else. Shortage of nurses happens due to bullying among nurses and this leads to issue such as nurses leaving their profession. Bullying is the main reason why new graduate nurses leave their profession. it is very important to eliminate bullying cycle.

The issue of bullying is now being addressed by The Joint Commission because it has a bad impact on interpersonal relationships on patients or on patient safety and quality of care. On January 2005, The Joint Commission issue a standard in hospital and other health care facilities, which is, all these health facilities must have a code of conduct in place that determines which behaviors are tolerated and which are not and also creates a formal procedure for managing any unacceptable behaviors. Eleven suggestions of action were given by The Joint Commission on the code of conduct, and one of them require nurse involvement. This new code of conduct is taken seriously by healthcare organization. This code of conduct helps an organization to practice or applying into the process of managing any inappropriate behaviors. Having this code of conduct in place helps healthcare organizations to have a better working environment which is safe for everyone.

However, bullying cannot be easily eliminated in workplace since the organization has made it a part of their daily job. Management or leaders or staff will take time to stop this issue but if this recommendations are applied into their daily practice then soon they can have a better work environment. Some of the recommendations are. Workplace norms should never include bullying, but it is possible to eliminate this embarrassment from the nursing profession. Education should be the first step, for example providing knowledge about what is horizontal violence and how can we prevent or reduce it, and this can be done through an awareness campaign organized by healthcare facilities. In this education information such as how to record the incident and other information’s related to this should be included. We can also stop the issue of violence by encouraging the staff to keep a log of incidence which includes, recording name of witness, confronting the aggression and making formal written complaints. It is important that a hospital administrators, human resource managers and nurse managers to be educated first to ensure that they have a clear understanding of their own responsibilities to a safe and healthy workplace, then they should encourage to educate their staff to prevent bullying behaviors. In addition, to truly change the environment for nurses, the employers must be willing to implement workplace rules. One step that was recommended by The Joint Commission is to adopt a zero tolerance policy for intimidating or disruptive behavior and also to incorporate this into medical staff and employment agreements. Organizational culture also play a very important role in eradicating the bullying practice in workplace, for example developing a human centred culture in working environment thus, this will reduce the incidence of lateral violence. Besides, empowerment can or do reduce the possibilities of increasing horizontal violence in workplace. Individual strategies include treating all employees with respect. Ensure to have eye contact when talking to colleagues to show that you are participating in the conversation and also for a better conversation. Agree to work with everyone regardless of whether you like them or not. Helping each other of any workload and when ever help is required. If all this is applied in a workplace then it is possible to have a pleasant working environment. A manager or a leader should not criticize any staff in front of others wherelse, they should be taking them to a side and explaining using diplomatic words. Lateral and horizontal violence can be reduced if staff and manager practice these strategies.

In conclusion, bullying is a serious workplace hazard among the nurses. Issues’ regarding tolerating horizontal violence is common problem which nurses are the main victims. Newly graduated nurses are at higher risk of experiencing bullying than compared to much more experienced nurses. Thus, this attitude has made many nurses leave their profession. It is important to educate new comers and other staff about adapting the strategies which was discussed in the essay to prevent bullying. For example strategies such as, encouraging manager or supervisor to work together on the floor and not really follow the hierarchical style, treating all the staff equally, fairly and also with respect. Lastly, with applying all of this in to nursing practice every healthcare or any organisation will have a better work environment and free from bullying issues. Therefore, eliminating or destroying bullying in nursing is important.

Appendix A

1. Name
Elaine (not real name) 2. Where did you complete your registered nurse course?
Queensland University of Technology 3. How long have you been working as a nurse after graduating?
8 months 4. Do you like your profession as a nurse?
Yes I do, because I get to learn a lot of new procedures everyday, and have been gaining more knowledge in nursing with my daily practice. I will say that nursing is a challenging profession which I am sure nurses would definitely enjoy it. 5. Are there or have you come across any difficulties at work ? workload is definitely the main thing I will say, after almost 3 weeks s of when I started I was already told to be on my own responsibilities, which I was not really happy with it. I am to remember where everything was kept in the ward and if I do not remember then the senior staff would embarrass me publicly, many times I tried doing it my way but they do not understand that sometimes everyone has their own way of doing things. 6. How do you feel about this issue?
It is difficult to explain, I just do not have an idea what to say, I feel incompetent sometimes. 7. Have you experience bullying at work place or Have you been bullied since you started working as a nurse?
Yes, Ganging up against me, or many time it happen that they ask me to do something which is below my competency level.

8.Did any of other new graduate came across this bullying issues?
Yes there are about 5 more new graduate nurse, over here the seniors uses forceful words on us, and I have also witness a bullying behaviour.

8. Did you take any actions regarding this behaviours?
I did not, because as I am still new here I would just want to observe the situation first.

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