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Bullying in nursing, especially involving new nurses, has been documented since the 1960s, leading to the coining of the phrase “nurses eat their young.” Every year, workplace violence among peers, otherwise called “horizontal violence,” causes large numbers of new graduates to either change jobs or leave the profession within their first year. What’s more, a plethora of studies link bullying to poor patient outcomes.
Most approaches at reducing violence have been top-down approaches within the workplace—yet, nearly 50 years later, this violence not only still exists, but thrives. Long story short, the current interventions are not the solution if we truly want to protect nurses from horizontal violence.
So where do we go from here? Logically, the implementers of change need to be nurses on the floor and at the bedside. Therefore, this means we need to shift the focus to nursing students, who seem to be the largest target and those most greatly impacted. As corny as it sounds, they are the future of nursing.
Extensive research shows that nursing students experience workplace violence during clinical rotations. However, even more student nurses are reporting incivility within the classroom. If a student is encountering hostility on all fronts and has no haven (outside of the ice cream aisle), then what? Circumstances place students in a vulnerable position. Classroom professors wield tremendous power: power to assign grades, provide letters of recommendation, assign preceptorships and influence employment. Clinical faculty have similar authority. At the risk of quoting Uncle Ben from Spider-Man (single tear), with great power comes great responsibility. Whether it is incivility in the classroom or a complete lack of effectiveness in teaching, nursing faculty and nursing schools appear to be failing students.
When nursing professors fail in their duties to teach and empower, they create insecure and less knowledgeable nursing students who turn into graduates with lower self-confidence and self-esteem. This doesn’t mean to imply that all nursing professors are bullies. However, they are not, unanimously, gifts to the educational process.
What is the connection between violence in nursing and nursing education? Well, to answer that, we turn to modern psychology.
Like nursing, psychology is also evolving. Once filled with “dreams” and “mothers,” modern psychology has grown and can now be used to solve problems in science, law and even business. Industrial/organizational psychology (I/O) evolved by taking psychological principles and applying them to a major source of stress in modern life: jobs. This is what makes it the perfect discipline to help nurses.
Nursing school faculty and educational institutions are arguably the first to influence the average student’s perception of the nursing profession. Currently, nursing faculty qualifications seem to circumvent any need for formal education regarding methods of instruction. From the get-go, this cripples the effectiveness of teachers and logically can create apprehension, frustration and low morale among faculty. I/O psychology suggests that empowerment and recognition are key to raising faculty morale.
Empowerment through open communication lines among employers and employees, strong leadership, mentorship, and accessible resources and training are essential and effective; despite the simplicity of these strategies, they are surprisingly underused. Recognition and rewards based on educational accomplishments also have been found to increase morale—everything from cold hard cash to awards and lunches. Any recognition of a faculty member’s quality of service and/or commitment to students can go a long way. Although it may seem a cliché, when people are made to feel good, they tend to return the favor to others. I/O also tells us when employees feel that they’re not given the proper tools to succeed, their motivation to perform at their best diminishes substantially. In a nutshell, poor morale leads to poor performance and frustration, possibly leading to the violence in the classroom that is being reported.
Nursing students appear to take the brunt of the frustration. Whether it’s through direct bullying at the hands of faculty or being told to go teach themselves the majority of the material, nursing students are on the losing end. Bullying and a lack of knowledge have been repeatedly linked to lower self-esteem in nursing students, thus making them more likely to bully others later in their careers. As you can see, this creates a vicious cycle of nastiness that appears to have neither beginning nor end.
Environments and cultural psyche do not change at the drop of an alcohol wipe. There will probably never be a magic bullet to eradicate all of bullying within nursing. However, there is ample room for improvement. Bullying within nursing is too problematic and the stakes are too high for this problem to be ignored and our approaches to remain unchanged. It’s time to stop suggesting “change” and start implementing new tactics. What better place to start than the beginning? Perhaps if we simply teach and empower our teachers, we’ll begin to see the change we need.
The good news is change is possible! It’s just going to take time, ingenuity, a lot of caffeine and willingness to change until something finally clicks and makes a difference.
Yaira Kurtzman, RN, BSN, and David Sexton both hold bachelor’s degrees from Mercer University with majors in psychology, and are both passionate about psychology, nursing and caffeinated beverages.