There’s a puzzling conundrum in the world of nurses and nursing that’s difficult to reconcile because most nurses are kind, caring, and compassionate with their patients but horrid in their treatment of other nurses. Backbiting, bullying, and otherwise ill-treatment are so common that it’s hard to imagine that a profession steeped in healing could be rampant with a scourge of unkindness and incivility. And yet here we are.
Nurses and the Ethos of Kindness and Compassion
Ask anyone about nursing; healing and empathy will be at the top. The Gallup poll repeatedly proclaims our trustworthiness and honesty, and many nurses receive praise for their choice of profession, even from perfect strangers.
Of course, we also periodically hear stories of a patient feeling mistreated by a crusty, burned-out battle-axe of a nurse — yet, overall, most patients likely have a story to tell of a nurse who went above and beyond.
“Nurses can be so caring and compassionate to their patients but cruel to each other,” states Dr. Renee Thompson, CEO and founder of the Healthy Workforce Institute, an organization that works with healthcare facilities with troubled workplace cultures and ingrained problem behaviors among their staff.
In light of these realities, if an ethos of kindness and compassion is a throughline that informs the majority of the care that nurses perform and how others view nurses, what about the profession causes its members to treat one another so poorly?
Nurses and Internalized Oppression
Theories have been suggested regarding why nurses commit bullying and maltreatment (aka horizontal or lateral violence). Internalized oppression is a psychological phenomenon that occurs when group members perceive themselves as oppressed by forces beyond their control and direct their frustration at their members.
In a 2012 paper published by the University of San Francisco School of Nursing and Health Professions, a picture is painted of the origins of nursing’s sense of oppression:
“Nurses are among people thought to be oppressed. The historical premise for this argument is that their practice is dominated by forces outside of the profession with higher status and power. In the late 1800s and early 1900s, women cared for patients in exchange for nurses’ training in hospitals. The male physicians and administrators who ran those hospitals served their own interests by receiving remuneration for the nursing care provided by the women with little or no compensation to the women. Furthermore, nursing practice was labeled the work of women, and the care they provided in the process of their work was valued less than services rendered by male physicians.”
If internalized oppression is potentially at the root, this points to the need to address these issues more robustly in nursing education, the workplace, and the nursing literature.
A Culture of Safety is Possible
“There is an epidemic of bullying and incivility in healthcare that not only affects morale and turnover but also affects patient outcomes,” Dr. Thompson recently shared.
She continues, “The problem is that healthcare organizations aren’t doing a good job of making sure their employees are equipped with the skills and tools they need to confront disruptive behaviors and oftentimes fail to set behavioral expectations from the beginning.”
Recent research published by the National Library of Medicine suggests that different domains of intervention are needed, including:
- Preventing future acts of bullying.
- Stopping incidents as they happen.
- Promoting others to act in the face of bullying based on fostering relationships, positive workplace culture, and increased administrative support.
The AMA Journal of Ethics observes that everyone is responsible for addressing these issues. They also state that healthcare organizations must “outline steps for individuals to take when they feel they are a victim of workplace bullying; provide contact information for a confidential means for documenting and reporting incidents; and establish procedures and conduct interventions within the context of the organizational commitment to the health and well-being of all staff.”
The AMA concludes, “When well-functioning professional teams are partnered with health systems with shared goals and values—and when leaders are committed to building systems that make it easy for team members to do the right thing—a culture of safety is possible.”
No matter which interventions we choose, confronting these behaviors contributes to employee retention, improved workplace culture, safe and efficient patient care, and even fewer medical errors.
A Broad-Spectrum Problem
The mismatch between how nurses treat one another and how they treat their patients is a puzzling irony. We may be perplexed, frustrated, angry, or sad, but the response we cannot afford is apathy and non-action.
Disruptive nurse behavior and the resulting negative workplace culture is a broad-spectrum problem needing a multifaceted response. As the AMA so aptly put it, everyone is responsible, and that responsibility is crucial to honor.
With more members of the nursing profession on board and more proactive responses by healthcare leaders and executives, these unhealthy and toxic workplace behaviors can be identified, documented, boldly addressed, and removed like so many weeds in an otherwise healthy garden simply waiting to bloom happily.
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