exploring bullying: implications for nurse educators

10
Exploring bullying: Implications for nurse educators Sharon L. Edwards a, * , Claire Frances O’Connell b a Department of Pre-registration, Nursing Faculty of Health Studies, Buckinghamshire Chilterns University College, Chalfont Campus, Newland Park, Gorelands Lane, Chalfont St. Giles, Buckinghamshire HP8 4AD, United Kingdom b Green Lawns, Kilmona Grenagh Co., Cork, Republic of Ireland Accepted 27 March 2006 Summary This article examines briefly the issue of workplace violence and bully- ing in the hospital environment, but more importantly how the same and different styles of bullying and intra-staff bullying are emerging in nurse education. The con- tent describes the aetiology of violence and bullying and their place in the National Health Service (NHS) including nursing. It explores bullying as the principle form of intimidation in nurse education, the different types and subtle forms of bullying, why individuals become bullies, dealing with and the consequences of bullying. The legislation, guidelines, policies are part of the recommendations for practice. c 2006 Elsevier Ltd. All rights reserved. KEYWORDS Bullying; Violence; NHS; Higher education; Nurse education Introduction In modern day society, it could be argued that vio- lence and aggression is a common aspect of daily life. Violence and abuse within the hospital setting occurs throughout the entire health care sector (Zernike and Sharpe, 1998; Wells and Bowers, 2002). Over the years, negative incidents including violence, harassment, and aggression and bullying have been steadily increasing. In the year 2002/ 2003, there were an estimated 116,000 incidents of violence reported in the National Health Service (NHS), 38,000 of which occurred in acute trusts including general hospitals (DoH, 2003), a rise by 13% from the previous year. In the same given year, there were an estimated 7700 incidents of harass- ment against health care staff (DoH, 2003). Due to this, morale is low, job satisfaction and enthusi- asm is diminishing, resulting in one of the main rea- sons why an increased number of health care staff is reluctant to work, or even opting to leave their profession. Yet the issues of violence remain un- der-researched, and it is only in the last decade they have received recognition. 1471-5953/$ - see front matter c 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2006.03.004 * Corresponding author. Tel.: +44 1494 522141x2123; fax: +44 1494 603182. E-mail address: [email protected]. Nurse Education in Practice (2007) 7, 26–35 www.elsevierhealth.com/journals/nepr Nurse Education in Practice

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Page 1: Exploring bullying: Implications for nurse educators

Nurse Education in Practice (2007) 7, 26–35

Nurse

www.elsevierhealth.com/journals/nepr

Educationin Practice

Exploring bullying: Implications for nurseeducators

Sharon L. Edwards a,*, Claire Frances O’Connell b

a Department of Pre-registration, Nursing Faculty of Health Studies, Buckinghamshire ChilternsUniversity College, Chalfont Campus, Newland Park, Gorelands Lane, Chalfont St. Giles,Buckinghamshire HP8 4AD, United Kingdomb Green Lawns, Kilmona Grenagh Co., Cork, Republic of Ireland

Accepted 27 March 2006

Summary This article examines briefly the issue of workplace violence and bully-ing in the hospital environment, but more importantly how the same and differentstyles of bullying and intra-staff bullying are emerging in nurse education. The con-tent describes the aetiology of violence and bullying and their place in the NationalHealth Service (NHS) including nursing. It explores bullying as the principle form ofintimidation in nurse education, the different types and subtle forms of bullying,why individuals become bullies, dealing with and the consequences of bullying.The legislation, guidelines, policies are part of the recommendations for practice.

�c 2006 Elsevier Ltd. All rights reserved.

KEYWORDSBullying;Violence;NHS;Higher education;Nurse education

1d

1

Introduction

In modern day society, it could be argued that vio-lence and aggression is a common aspect of dailylife. Violence and abuse within the hospital settingoccurs throughout the entire health care sector(Zernike and Sharpe, 1998; Wells and Bowers,2002). Over the years, negative incidents includingviolence, harassment, and aggression and bullyinghave been steadily increasing. In the year 2002/

471-5953/$ - see front matter �c 2006 Elsevier Ltd. All rights reseroi:10.1016/j.nepr.2006.03.004

* Corresponding author. Tel.: +44 1494 522141x2123; fax: +44494 603182.E-mail address: [email protected].

2003, there were an estimated 116,000 incidentsof violence reported in the National Health Service(NHS), 38,000 of which occurred in acute trustsincluding general hospitals (DoH, 2003), a rise by13% from the previous year. In the same given year,there were an estimated 7700 incidents of harass-ment against health care staff (DoH, 2003). Dueto this, morale is low, job satisfaction and enthusi-asm is diminishing, resulting in one of the main rea-sons why an increased number of health care staffis reluctant to work, or even opting to leave theirprofession. Yet the issues of violence remain un-der-researched, and it is only in the last decadethey have received recognition.

ved.

Page 2: Exploring bullying: Implications for nurse educators

Exploring bullying: Implications for nurse educators 27

The perpetrators in hospital settings are mainlyrelatives and patients (Vanderslott, 1998). Bullyingcan occur between different staff members and be-tween professional groups and from managers.Such acts have infiltrated into the nursing profes-sion (Jackson et al., 2002) and are currently rifewithin higher education (Cooper, 1999) where theeducation of nurses is now placed. In addition,there is reason to suspect that the occurrence ofbullying practices have transferred via recruitmentfrom the hospital setting to higher educationinstitutes.

Nurse educators are now becoming the victimsof such horrendous acts, increasing the stressesof working life and few are equipped to deal withbullying (Cameron, 1998). The immense impactthat bullying can have on a nurse educator’s phys-ical, psychological and emotional well being is pro-found. Yet, accepting approaches to such acts arestill common (Beech, 2001).

Aetiology of violence and bullying

The World Health Organization (WHO, 2002a,2002b) proposes various terminology to applyto and incorporate violence of all forms physi-cal violence, psychological violence, assault/attack, abuse, bullying/mobbing, harassment,sexual harassment and racial harassment (Table1). The World Health Organisation (WHO 2002a,p. 3) defines violence as:

‘‘The intentional use of physical force or power,threatened or actual, against oneself, another per-son, or against a group or community, that either

Table 1 Types of violence and aggression

Type of violenceand aggression

Common types reported

Verbal abuse Angry tone of voiceYelling and screamingThreats against the institutionDerogatory remarksIntimidation

Physical abuse Threat of physical violenceActual bodily harmHitting, hitting across the headBitingKickingScratchingPushing against the wallAttempted strangulation

(Mayer et al., 1999; Cameron, 1998; O’Connell et al., 2000).

results in or has a high likelihood of resulting ininjury, death, psychological harm, mal-develop-ment or deprivation.’’

Workplace violence has numerous words used todescribe it including aggression, harassment, bully-ing, assault and intimidation, and the perpetratorsof such acts include patients, relatives, nurses andother various health care professionals (Jacksonet al., 2002). Budd (2001, p. 1) attempts to defineworkplace violence:

‘‘All assaults or threat’s which occurred while thevictim was working and was perpetrated by mem-bers of the public.’’

Bullying is often considered under the heading ofviolence, but due to its more subtle nature re-search is emerging whereby it is separated (Ball,2003; Bray, 2001; Normandale and Davies, 2002)(Table 2). Bullying or workplace bullying has notbeen officially defined, bullying alone is a new phe-nomenon, and is open to many interpretations.Randall (1997: p. 1) proposes a variety of termsincluding:

‘‘. . .verbal unpleasantness, the threat of violenceor painful physical contact, being on the receivingend of rumours and vicious gossip or maybe out-right rejection by family or colleagues at work.’’

Violence, aggression, harassment and bullyingare emotional issues for the victim involved, aredetrimental to the victim’s health, especially ifphysical or psychological trauma is involved. Unfor-tunately bullying is rife in the health care sector,especially in the nursing profession, and is pro-posed to occur within higher and nurse education.Yet research studies into its occurrence in nurseeducation are very limited.

Violence and bullying in the NHS

Although violence and aggression has been a recur-rent issue in the nursing profession, it is only in thepast decade it has received recognition. Therefore,it is difficult to ascertain the true frequency of vio-lence and aggression occurring in the NHS beforethe last decade, but Vanderslott (1998) suggeststhat it is an immense problem.

The British Crime Survey (BCS) found therewere an estimated 849,000 incidents of violenceand aggression at work in England and Wales in2002/2003 (Budd, 2001). ‘High risk’ professions in-cluded police, firemen, and health and social careassociates including nurses. The BCS found that3.3% of health and social care associates were

Page 3: Exploring bullying: Implications for nurse educators

Table 2 Types of bullying behaviour

Type of abuse Descriptions

Verbal abuse � Using offensive language or innuendo� Sexist, racist or patronising remarks� Telling racist, sectarian or sexually suggestive jokes� Inappropriate or intimate questioning, uninvited,unreciprocated unwelcome behaviour of a sexual nature� Derogatory statements of a sexual, racist or sectarian nature� Propositions and offensive remarks� Name calling, including personal comments about physical looks� Language that belittles a person’s abilities� Spreading malicious rumours or hurtful gossip

Written abuse � Written abuse such as letters, faxes or e-mails (often anonymous)

Physical abuse � Unwanted physical contact� Explicit physical threats or attacks� Suggestive gestures (such as mimicking the effects of a disability)� Unnecessary touching or assault� Stalking which occurs at work or outside of work, but is related to work

Intimidation � Slander, music and ‘party tunes’� Conduct that belittles in some way, such as being shouted at� Intrusion by pestering, spying, following� Unnecessary closeness� Apportioning blame wrongly

Displays of offensive material � Flags and emblems� Badges� Graffiti� Unnecessary highlighting of differences

NHS Zero Tolerance Zone (NHS, 1999).

28 S.L. Edwards, C.F. O’Connell

assaulted at work, and 2.3% threatened at work in2002/2003. Nurses are prime targets of violenceand aggression as they are principle carers whoare in contact with the patient 24 h a day (Van-derslott, 1998).

In October 2003 the Commission for HealthImprovement (CHI 2004), in conjunction with theNational Health Service (NHS) conducted one ofthe largest workforce surveys ever. The findingssuggested that 37% had experienced harassment,bullying or abuse at work in the previous 12months this is an extremely high and worryingamount of employees in the NHS who are exposedto bullying behaviour. A high percentage of staffwitness bullying occurring to other colleagues(Quine, 1999).

In 2000, the Royal College of Nursing (RCN,2000) produced a quantitative questionnaire sur-vey of 6000 RCN members in the UK, excludingstudent nurses, looking specifically at their wellbeing and working lives in the health sector. Thefindings reveal that over the previous 12 monthsof the study, 20% of nurses had been assaultedat least once, 12% of nurses had been assaultedat least once a week, and 3% experienced assaulton a daily basis. Just under half of the respon-dents (49%) had been harassed and assaulted2–6 times in the previous year.

Statistics produced by Poster and Ryan (1993)show that physical assault is worryingly high. So-field and Salmond (2003) and O’Connell et al.(2000) suggest the perpetrators of violence andbullying towards nurses are mainly patients, rela-tives and in some instances doctors, but also in-cludes supervisors and colleagues.

Types of NHS violence and bullying

Experiences that were more common included ver-bal abuse, intimidation, and the threat of physicalassault and actual bodily harm. Verbal abuse is be-lieved to be a frequent problem (Mayer et al.,1999). In Cameron’s (1998) study an angry tone ofvoice was the most common form of verbal abuse,then yelling/screaming, threats against the institu-tion and derogatory remarks. The most commontypes of physical assaults reported included biting,kicking, hitting and scratching.

Assaults that are more serious included hittingnurses across the head, pushing nurses against awall, and attempted strangulation (O’Connellet al., 2000). This may not be so shocking if the pa-tient had a known mental or physical condition, butin these instances there is no mention of suchoccurrences.

Page 4: Exploring bullying: Implications for nurse educators

Exploring bullying: Implications for nurse educators 29

Violence and inter-staff bullying withinhealth care professionals

Workplace bullying can include negative criticismor sarcasm in a direct or subtle way (Normandaleand Davies, 2002). However, different bullyingstyles vary between diverse groups’ newly quali-fied nurses, experienced nurses and junior doctors(Table 3). The study by McKenna et al. (2003)investigated nurses’ experience of bullying in theirfirst year of practice and bullying therefore maybe related to levels of experience. Another studyby Brennan (1999) used a questionnaire circulatedat a nursing conference to identify the types ofbullying occurring. Different types of bullying oc-curred between these professional groups.

Quine (2003) also carried out a quantitativestudy to investigate the prevalence of inter-profes-sional bullying amongst junior doctors the nature ofthe bullying again differed from that of McKennaet al. (2003) and Brennan’s (1999) study. It maybe suggested that inter-staff bullying in nurse edu-cation might be different again from bullying thattakes place between practice nurses and juniordoctors. However, it is not how the perpetratordelivers the bullying and what form it takes, it isthe stress experienced by the individual that con-stitutes the bullying.

Types of inter-staff bullying

Farrell (1997) included innuendo, putdown,threats, intimidation and actual physical violenceand identified more subtle forms of bullying, suchas one person putting down another person byraised eyebrows, snide remarks and turning away.Bray, 2001, p. 21) included inter-staff bullying ina definition:

Table 3 The different types of intra-staff bullying identifi

McKenna et al. (2003) investigatednurses’ experience of bullying in theirfirst year of practice

Brennan’s (1999) stquestionnaire was hnursing conference

� Qualified but treated like students� Undervalued by their colleagues� Having learning opportunities

blocked were forms of bullying� Rude, abusive, humiliating or

unjust behaviour toward them� Verbal sexual harassment� Racial comments� Inappropriate gestures

� Humiliation� Undermining auth� Criticism of work� Unreasonable req� Intimidation� Exclusion from gr� Threat of dismiss� Offensive languag� Denial of work re

‘‘. . . a form of harassment which involves persis-tent, intimidating behaviour, usually by a supervi-sor toward an employee. It can include repeatedunfounded criticism in front of colleagues, con-stant nit-picking over trivia, the use of offensivelanguage, lying, over-monitoring, isolating an indi-vidual, and withholding information to ensure thatan individual fails to achieve a given task’’

Other indirect experiences reported by partici-pants included refusing to lend a hand, talkingabout people behind their backs with other col-leagues, excluding one from conversations, with-holding information thus detrimentally affectingtheir career and holding staff on duty when theyare officially finished (Farrell (1997). These formsof bullying behaviour are so subtle, the victimsmight not even be aware of it occurring.

The perpetrators of inter-staff bullying

There is still a small proportion (28%) in thesestudies that stated peers, and 16% stated thatsupervisors were common perpetrators of abuse.The Royal College of Nursing (RCN, 2000) reportedthat the most common sources of bullying werethe nurse’s immediate supervisor or manager.Similar findings were identified in McKennaet al.’s study (2003) whereby the most commonperpetrators listed were who the nurses wereaccountable to.

It appears that in some instances a commonsource of intimidation is from nursing peers, clini-cal nurse specialists and managers. These findingsconvey the high extent of unseen aggression in-flicted upon nurses by their colleagues and manag-ers. These issues need to be exposed andappropriately addressed to stop such distressingevents, promoting a safer and harmonious working

ed between professional groups

udy aanded out at a

Quine (2003) investigated inter-professional bullying amongstjunior doctors

ority

uests

oupsalesources

� Destructive innuendo� Other colleagues attempts to

belittle and undermine theirwork

� Unnecessary excess pressure toproduce work

� Unjust and constant criticism ofwork

� Public humiliation� Goalposts shifted in their work

without prior warning

Page 5: Exploring bullying: Implications for nurse educators

30 S.L. Edwards, C.F. O’Connell

environment for nurses and other health careprofessionals.

Bullying within higher education

There is no doubt that violence and bullying is awidespread problem within society and in theNHS, mainly towards and between different healthcare professionals. Yet, violence in higher educa-tion (HE) may not be as prevalent as bullying asdemonstrated by current literature. Numerous re-cent surveys have highlighted the problem of bully-ing, including occurrences in universities andcolleges. A survey of 800 members of the lecturer’sunion NATFE in Wales reported that 18% of lecturershad been bullied, 25% had been told by colleaguesthat they had been bullied, 22% had witnessed bul-lying (Lewis, 1999). In this study workplace experi-ence of bullying was ranked higher than sexdiscrimination, sexual and racial harassment. In aNATFE sponsored study of more than 300 membersin England, it was found that 22% had recently expe-rienced bullying (Cooper, 1999).

However, if bullying occurs in HE it cannot auto-matically be stated that it happens in nurse educa-tion as the research articles examined are notspecific to nurse education. However, the educa-tion of nurses is now part of HE, which may ormay not be significant, it is hard to tell with suchlittle evidence to refute or support this, but moreimportantly lecturing staff are generally recruitedfrom the health care sector. The bullying thattakes place within the NHS between colleaguesand peers and from senior management, could betransferred into nurse education through recruit-ment. The investigations and literature into bully-ing in HE and within the health care sector couldbe transposed into nurse education. Bullying innurse education could therefore wear the samemask as that which is present in the NHS and withinhospitals. It includes the use of persistent harass-ment and psychological intimidation and the moresubtle forms of bullying identified by Farrell(1997, 1999).

The bullies who shout and publicly humiliatetheir subordinates or colleagues are easy to iden-tify. There are more subtle forms of bullying thattakes place such as negative criticism or sarcasmwhich, demean and humiliate the victims in a devi-ous but ingenious way (Normandale and Davies,2002). As previously stated bullying between dif-ferent professional groups varies, bullying in nurseeducation may differ again from bullying that takesplace between practice nurses and junior doctors.

The differences might include being treated like astudent by line managers, undervalued by col-leagues, achievements being ignored, having learn-ing opportunities blocked (McKenna et al., 2003),which is detrimental to career progression andpromotion.

Other suggestions include holding staff at meet-ings or in the office when they are officially fin-ished, undermining authority, and criticism ofwork, making unreasonable requests, intimidation,exclusion from groups, threat of dismissal or writ-ten or verbal warning (Brennan’s, 1999). In Quine’s(2003) study the type of bullying was unnecessaryexcess pressure to produce work, shifting of goalposts without prior warning.

There are in addition even more underhandforms of bullying, where it can be hidden or bullyingbecomes subtler (Cooper, 1999). Subtle or smartbullies:

� Set their staff up to fail, by withholding ormanipulating information.� Calling meetings when staff are not available.� Isolating workers from colleagues.� Criticising them for minor mistakes.� Undermining their self-confidence by ignoringtheir successes.

Bullying styles may evolve and change and varybetween different professional or disciplinegroups. Bullying in HE and within nurse educationmay well be more wily or conniving than bullyingtaking place elsewhere and as such particularlymore difficult to determine. These forms of bully-ing behaviour are so subtle, the victims might noteven be aware of it occurring. In this instance thefault may lie with others who allow subtle bullyingto be maintained against others in their presencewithout actually doing anything about it.

Why individuals become bullies

Paterson et al. (1997) suggests that the perpetra-tors of bullying have been bullied themselves, yetthey still continue to harass others. There are al-ways a small number of individuals who revealtheir insecurities when they reach positions ofinfluence. In a managerial system whereby a hier-archical type of organization exists such as in HE,Farmer (1993) states that bullying occurs becausethe individual has a superior position over othersand violates their power and over rates theirown importance. Kolanko et al. (2006) reportedthat certain events separate from the academic

Page 6: Exploring bullying: Implications for nurse educators

Table 4 The consequences of bullying behaviour

Area effected Symptom caused

Physiological HeadachesSweating/shakingFeeling/being sickIrritable bowelRaised blood pressureInability to sleepLoss of appetite

Psychological AnxietyPanic attacksDepressionA feeling of dreadTearfulness

Behavioral Becoming irritableBecoming withdrawnBecoming aggressiveIncreased consumption oftobacco/alcoholObsessive dwelling on the bullying

Normandale and Davies (2002).

Exploring bullying: Implications for nurse educators 31

setting may lead to bullying behaviours, includingfailure to achieve a goal, thwarting of ambitionsand wishes feeling threatened. This list has rele-vance for nurse education. These individuals mayhave low self-esteem and try to enhance theirself-worth by demeaning others; or they feel sothreatened by a high-flying colleague that theybully them to try and defuse the threat they pose(Cooper, 1999).

One theory of why individuals become bullieswas proposed by Bray (2001). Bray suggests thatworkplace gender segregation, which can be foundin careers such as nursing, and nurse education in-crease’s the frequency of same-sex bullying. Bray(2001, p. 23) states

‘. . .people tend to work with colleagues of theirown gender, there is a tendency for women to bullywomen and men to bully men.’

This theory is reflected in Quine’s (1999) study,where in 57% n = 137 of incidents reported the bullywas the same sex as the victim, and in Farrell’s(1997) exploration of clinical aggression, theparticipants stated their prime concern was contin-ual intra-staff woman to woman aggression andbullying.

The big issue of bullying today in HE is amongthe overloaded bullies, those who are unable tocope with their workload, with difficult staff, withtheir or others’ career problems or with auto-cratic superiors (Lewis, 1999). HE institutes havetaken up the private sector culture. Academicshave to deal with high workloads, long and unso-ciable hours, job insecurity; performance-relateddemands are being imposed, power imbalance be-tween managers and academics, and a more topdown, bottom line management style. Therefore,in all departments within HE some individualsuse bullying as a management style. There is noreason to believe that the workload of nurse edu-cators is any less demanding than other HE aca-demic staff.

There is a lack of professionally trained manag-ers (Lewis, 1999). This enhances the problems asthe majority of managers within nurse educationare appointed on the basis of their research compe-tence, volunteer to undertake an academic role toenhance their career opportunities, rather than fortheir management skills. When these managers findthemselves with a work overload, staff conflict orfinancial crisis, their lack of managerial skills leadssome of them to ‘manage by bullying’ (Cooper,1999).

The two most prominent features that are likelyto have an impact on workplace bullying withinnurse education are the lack of professionally

trained middle and senior managers, same sex bul-lying as the majority of nurse lecturers are women,and a power imbalance between managers and lec-turers (Lewis, 1999).

Consequences of bullying

The consequences of intimidation and bullying canhave an immense impact on a nurse educator’smental, physical and emotional well being. The re-sults of such behaviour can be immediate, shortterm and long term affecting their personal andprofessional lives.

Naab (2000) states that regardless of the sever-ity of the aggression, or if it had been actuallyexperienced or witnessed, the effects of its impactwere the same. In O’Connell et al.’s study (2000);the most common feelings experienced were frus-tration and anger. Fear and emotional hurt closelyfollowed. There were also various reactions by par-ticipants in their study some took sick leave andchanged their job. Sofield and Salmond (2003)found that following incidents of verbal abuse,there was decreased morale, productivity and in-creased errors at work.

Rippon (2000) highlights the key individual re-sponses including people giving up their jobs toavoid the perpetrators, victims experiencing psy-chological stress, recurring nightmares, re-experi-encing the trauma and moodiness. Normandale

Page 7: Exploring bullying: Implications for nurse educators

32 S.L. Edwards, C.F. O’Connell

and Davies (2002) listed various physiological, psy-chological and behavioural effects nurses haveexperienced due to bullying behaviour, such asfeeling/being sick, inability to sleep, anxiety,becoming withdrawn and dwelling on the bully(Table 4).

Dealing with bullying

In Sofield and Salmond’s (2003) study the verbalabuse is frequently accepted as part of the job,and many would rather not deal with the situation.Some took precautionary measures by documentingincidents or sought legal advice. Others used avoid-ance strategies instead of confronting the issue.When discussing their course of action some re-quired time alone to regroup their thoughts orsought support from colleagues.

McMillan (1995) highlights that it was probablefor individuals to seek practical and emotional sup-port from loved ones talk with a partner or friend orcolleague. Nurse educators may not be comfortableusing a colleague, who is of the same sex, as theymay be the perpetrator of the bullying. A small pro-portion of respondents did not discuss the matter orseek help from anyone. The course of action takento deal with the issue of bullying is varied (Table 5).McMillan (1995) found that some respondents were

Table 5 Dealing with bullying

Techniques What you can do

Verbal techniques Express your feelings to thewhat he or she is doingReassure the personUnderstand the bullies angeModel calm behaviourProvide cautious remindersOne-to-one (not isolated) cMirror perpetrators behavioTalk about it to a colleagueGo above the bully’s head (Discuss it with human resouTalk to the representative f

Non-verbal techniques Keep eye-contact with theMove further away from theAppropriately use touchUse the limitation of the suProvide a change of topic to

Writing down incidence Keep a written record of timWrite to the bully and againKeep copies just in case

Modified from Garnham (2001) and Brennan (1999) (a study which

actually confronting the perpetrator and discussingthe problem with them, and more than half of therespondents found this course of action successful.Confronting the perpetrator is one way a nurse edu-cator can deal with bullying.

An unexpected unhelpful source for dealing withbullying was line managers. Although just over aquarter of respondents talked with their line man-ager only a very small proportion (6%) found thisaction helpful (McMillan, 1995). In relation to nurseeducators this may be because the line manager isa source for the bullying. In general support issought from friends and family, but few reportthe incident (Cameron’s, 1998).

The lack of reporting bullying within universitiesand nurse education may because these institutionsdo not have mechanisms to deal with bullies. Thereare no procedures for staff to disclose bullyingexperiences safely, no counseling for the bulliedor disciplinary or training strategies to deal withthe bully. In a study by McMillan (1995) the use ofa counselor following bullying was surprisinglylow, yet a high proportion found this source mosthelpful.

Many private business and firms have anti-bullying policies and procedures to allow employ-ees to reveal the problems (Davies, 2002). Theyemploy trained staff to gather evidence and, sub-sequently discipline or train bullies. Collins (1994)looked at attitudes towards bullying following their

individual, tell them to stop

r

ommunicationur

to his or her boss!)rces (personnel)rom your professional association

perpetratorperson

rrounding space to calm the individualrefocus the unwanted attention

es, dates and incidentsrequest that he or she cease the bullying behaviour

investigated types of bullying that occur in nursing).

Page 8: Exploring bullying: Implications for nurse educators

Exploring bullying: Implications for nurse educators 33

attendance at ‘The Prevention and Management ofAggressive Behavior Programme’ (PMAB). The studyprovides evidence that training and education playsa key role in successful management of aggressiveand bullying behaviour, and that it does contributeto staff confidence when bullying occurs. Universi-ties too must train senior staff in people manage-ment and develop ways of tackling the growingproblem of subtle and cunning bullying.

Recommendations for practice

All employees including nurse educators should nothave to experience any form of violence, aggres-sion or bullying behaviour. There are various na-tional and governmental policies, guidelines andlegislation from 1974 to current day to protectthem from such ordeals (HMSO, 1974, 1977, 1996;

Table 6 The recommendations for practice

Recommendation Outcome

The acts of violence and bullyingfrom one individual to anotheropposes the Principle ofBeneficence and Non-Maleficence (Hendrick, 2001)

� Violence and b� An infliction o� Bullying contragard the recog� Acts of bullyinCouncil’s Code� The perpetrataccused of pro

Education and training – One ofthe greatest methods forovercoming change is througheducation (Ewles and Simnett,1999)

� Formal prepar� Education andof inter-stafftechniques.� Attendance atopment progra

The provision of information(Naab, 2000)

� Awareness of bthrough releva� A complaints p� Employees neeing will not be� Confidential coguidance with� Booklets, leaflable for staff

The provision of policies andguidelines (NHS, 1999; Ball,2003; Quine, 1999)

� Bullying is notversity wide a� A formalised pthose which do� The specific po

Further research (Cormack, 2000;Upson, 2003)

� Further researcifically within� In order for natackle the issuin order to est

Upson, 2003). A directive called ‘Zero Tolerance’from the Health Minister John Denham in 1999, inconjunction with the NHS (NHS, 1999) set aboutpreventing violence and bullying incidents. Thisdirective not only addressed the physical and ver-bal abuse that staff were subjected to by patients,visitors and members of the public, but aimed atstaff attitudes towards each other. Yet, in this re-port nurse education was not referred to, and maynot have relevance as it is dealing with clearerareas relating to violence and bullying.

In order for a change in the working environmentto occur, various actions must occur. Primarily,nurse educators’ must accept that there is a needto alter practice, and have a shared vision of ahealthier working climate. Nurse educators needto identify the problems that exist and work to-gether diligently to eliminate them (Kolankoet al., 2006). Although some nurse educators may

ullying causes emotional and psychological distressf immense harm upon an individualdicts the principle of respect, as such actions disre-nition for an individual’s autonomyg oppose clause 4.2 of the Nursing and Midwiferyof Professional Conduct (NMC 2002:6)ors of bullying, who are registered nurses, shouldfessional misconduct for breaching this clause

ation to deal and cope with bullyingtraining should be provided on policies and protocolsbullying, as well as management and interpersonal

study days, inclusion in continual professional devel-ms and induction training

ullying, HEI have an obligation to provide informationnt meansrocedure against bulliesd to be appropriately informed that intra-staff bully-tolerated and is unacceptableunselling services, hotlines provided for staff to seekout fear of retributionets and internal memos should be made readily avail-

a ‘fad’ and HEIs need to work towards a general uni-nd local discipline specific policyolicy including what actions constitute bullying andnot, common groundlicies may differ significantly between disciplinesch is needed in intra-staff bullying within HE and spe-nurse educationtional and local organisational bodies to effectivelyes of workplace bullying, further research is requiredablish what specific areas needs to be focused upon

Page 9: Exploring bullying: Implications for nurse educators

34 S.L. Edwards, C.F. O’Connell

resist change, as they may believe the change isnot in their interests (e.g. the perpetrators ofaggression may believe they should not have tochange their practice). The recommendation forthe practice base of nurse education is to considerthe ethic of caring between each other, educationand training, the provision of information, newdirectives, policies and guidelines and the needfor further research (Table 6).

Conclusion

The frequency of both violence and bullying in theNHS and against nurses is of concern. The types ofaggression include verbal and physical abuse, allof which are found to be common actions bypatients, visitors, members of the public, andeven work colleagues. Many of the nurses statethey accepted abuse as part of the job, and donot seek support or know where or how they couldaccess the relevant resources in their area ofemployment.

The issue of workplace bullying is significantlyunder-researched, and yet it exists. Studies thathave investigated this issue have found that thefrequency of bullying behaviour within universitiesis a common occurrence, ranging from implicit ac-tions such as refusing support at work to explicitactions such as direct humiliation or offensivethreatening language. The education of nurses isnow part of HE and lecturing staff are generallyrecruited from practice areas within the NHSsector. Bullying in nurse education is similar tothat present in the health service, but proposedto be different in that it can be more subtle andwily.

The consequences of bullying have a detrimentalimpact on nurse educator’s psychological and phys-ical well being. There is evidence of numerousphysiological responses to bullying such as beingsick, anxiety, and insomnia, as well as variousbehavioural and psychological responses manifest-ing as depression, moodiness, nightmares and beingwithdrawn from friends and family. These are nothealthy coping mechanisms, and no individualshould have to endure such horrific experiences,especially in their daily working lives.

The issue of bullying in nurse education and thedifferences in styles of bullying desperately needsfurther investigation. This is in order for the prob-lem to be effectively tackled, but due to the as-tute, guile and sly manner in which this type ofbullying manifests itself this may be difficult. Bully-ing in nurse education is an on-going problem thathas yet to be appropriately acknowledged by

governing, professional bodies, as well as univer-sity policy organisers and local departmental man-agers. Abusive behaviour, albeit emotional orphysical is not acceptable in any career and nurseeducators are not an exception.

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