« Who Tells a Patient’s Family That Their Loved One is Dying? | Main | It’s Pulp Fiction Week at Change of Shift »

September 03, 2008

Joint Commission Rallies Against Nurse Bullying

I am in total surprise that the Joint Commission has decided to focus on nurse harassment and bullying, along with lateral violence in the workplace. We all know that it exists. But, is it the role of a national agency that accredits hospitals and care standards to address this ongoing, worsening problem? Is the Joint Commission going to create a standard of some sort? Will it really be effective in stopping lateral nurse violence? I don’t think so.

I do think  practicing nurses need to reassess  behavior towards our colleagues. We each are responsible for ourselves. If we can’t act compassionately to ourselves and colleagues, how can we be compassionate to our patients? And what about the role of nursing administrators in enforcing policies against discrimination, harassment, and lateral violence within staffs and units?

Should punitive disciplinary actions be taken against those nurses participating in lateral nurse harassment or violence? Should they be allowed to continue working as nurses? What are your thoughts?

The Joint Commission Sentinal Event Alert
Behaviors That Undermine a Culture of Safety

September 3, 2008 in Beka | Permalink

Comments

As a head nurse I have been reported as a bully...which is not true. As a manager I have no agency support. Removed temp for investigation. 20 years without one blemish to my career.Has anyone else experience such, humiliating and demeaning issues.

Posted by: Joyce baker | Oct 15, 2011 8:34:25 AM

As a head nurse I have been reported as a bully...which is not true. As a manager I have no agency support. Removed temp for investigation. 20 years without one blemish to my career.Has anyone else experience such, humiliating and demeaning issues.

Posted by: Joyce baker | Oct 15, 2011 8:34:24 AM

I am a new nurse and am being harassed by three nurses on our unit, which is a very busy step down pulmonary unit. It seems cultural: they are Phillipinos. they are nasty, unprofessional and personal in their attacks. I've complained three times and each time was told that I should reach out to them with an olive branch. I'm ready to go to HR but don't want to jeopardize my job or be seen as a troublemaker. Ironic, since I'm the professional acting, mature one of the bunch.

Posted by: jane | Sep 20, 2011 8:21:42 PM

I guess I should feel better about all the bullying I've encountered, reading that it has happened to so many others. But which of us wants to be in this club? Not those of us who believed the hype about the "noble" profession of nursing. Here it is March, 2011, and the Indiana State Nursing Association bulletin's lead story is about "lateral violence." It's written as if it's just been discovered. Clearly, since this blog and the responses to it were written 2 years ago, nothing has changed and the situation has probably gotten worse. I know I can't wait to get out of nursing. My question all along has been: if I can get fired for all kinds of infractions, if I can lose my license for many types of misdeeds, how come nursing regulators can't find a way to outlaw bullying? It's not like they don't have the tools. I asked this question of the ISNA weeks ago - still waiting for an answer. Isn't this casual idifference a sort of bullying? Isn't it what the bullies count on?

Posted by: margie | Mar 22, 2011 12:34:21 PM

In response to Tina, posted Sept 21, 2008.
My first job out of an LPN program had me responsible for total patient care over 18 fresh post-op patients. I had one attendant to assist with vital signs. I was clueless when it came to cliques, cultures, workplace climates and atmospheres back then.
One of my patients had experienced a surgery on his eye, it was bandaged and covered with a metal eye-cup. The patient had orders for an antiemetic should he become nauseous. Shortly after getting report I made rounds on my patients. I discovered on the patients notes that he had 300 cc of emesis and the tech had written "TL notified." I asked her if she had tried to inform me of the patient's emesis, and her response was, "No, cuz I can't stand your face anyway!"

I turned and walked away from her, and immediately reported the incident to my charge nurse and provided the patient with his antiemetic. Later I wrote the incident up and passed it on to the Unit director. No sanctions were brought against this tech, not for endangering the patient, not for falsifying medical records, not even for insubordination, she was put back on the floor.
I can not make the judgement calls for the tech, nor can I make the judgement call for the Unit Director, but I could remove myself from what I quickly percieved as a hostile, even dangerous environment. I told the Unit Director she could either accept my two week notice or allow me to transfer to another unit. I was transferred.
I went to L&D, and although not free of workplace conflicts, I did have greater autonomy with my patients, and more importantly gained a Unit Director on the lookout for nurses with growth potential. She pushed me and made me know that an education is something we do inspite of all life's grief coming at us at once. I remained in school at her prodding until I gained my BSN.
The nurse to nurse bullying is going to occur no matter where you work, the question becomes, what can I do about it? We cannot change others, we can become the change we want to see in the world, the workplace or the unit we choose to practice our profession in. We have to first know ourselves well enough to know when we have experienced our limit of abuse, and either deal with it proactively (preferrably) or reactively. We are either a part of the solution or part of the problem, the choice is ours.

Posted by: April Hopkins Freeman RN BSN MBA/HCM | Nov 1, 2010 2:01:05 PM

jayn,

I feel your pain. Although each experience is unique, I too was in nursing school and close to graduating--about 1 year away from my BSN. I had matriculated from CC with a 4.0 in my prereqs and held a 3.6 in nursing school. I was doing well in clinicals, but after being certified with a learning disability, my clinical instructor harrassed and intimidated me constantly for a few weeks and I was asked to leave the program.

Another nursing student from my school also asked for a disability accomodation, and was asked to leave the program. He had a prior bachelor's degree and was 3 months away from graduation. He is now having to start all over at another college, still determined to be a nurse.

All the complaints I have lodged against the college have been ignored and shelved, and there seems to be no one to advocate for us. The good grades and positive evals we got previous to the harrassment really don't seem to mean anything, so the instructors are off the hook even in spite of hideous behavior that is both illogical and at times endangers patients.

I hope the Joint Commission takes these complaints seriously, because nurses "eating their young" is not a myth, it's a reality entrenched in this culture. It's hurting the profession of nursing (their low numbers and high ratios), hurting the patients, and hurting the individuals so heavily invested in a career that is at once taken away from them.

Posted by: J | Oct 27, 2010 2:07:13 AM

I have been nursing over 30 years and canot belive the way things have changed,there was a time when nurses would defend the person who was geting bullied.
Recently it has been myself who has been on the receving end of medics who did not like the fact i spoke out about an incerdent,i whent to the manegers only to receve no suport.I was bullied so much i had a breakdown and was off sick for 8 monthes.The union dident help in anyway, i am back at work only due to the fact that i wont let the bullies win and i car about the patients.

Posted by: jo | Sep 28, 2009 7:42:53 PM

I am a male LPN. Only four years now. With nearly 6 jobs behind me over that time. First one --another LPN coughed in my face and told me I needed to be ill like the rest of the staff. It only got worse. When I filed a harassment complaint to my boss- the real company harassment began. I have continued to experience this at every job. The latest the CNA's have filed another complaint about me asking them to work at night I ask them to perform their rounds. An RN confronted me blamed me for orders that were missed by two other nurse's and myself (I came in for 4 hours to help out) only after I had been told the orders were being pulled. So I thought they were, I did not double check. I use to believe we were helping people. We are not. We dispense medicine and take shit from everyone. I am sick of this field and will NEVER recommend to anyone to go into it. Good luck with changing attitudes and harassment in America.I have been in the medical field since 1995 I started as a caregiver for hospice. Never again I gladly give this up.

Posted by: Derrick | Aug 27, 2009 1:42:50 AM

Up until about three days ago I did little investigating, regarding bullying, although I have pretty much experienced it most of my 30+ year nursing career. There are several states that are currently involved in enacting bills to alleviate the issue. For NY state residents, the website is www.nyhwa.org. All who have suffered, under the hand of an 8th grade mentality, will find the information very interesting.
I used the JCAHO mandate, regarding intimidation, when talking with my supervisor the other day, as a tool in getting her to listen to my complaint about a nursing assistant.

Posted by: Marilyn | Aug 6, 2009 10:45:23 PM

In addition to JCAHO taking action against bullying, I would also like for them to specify what they consider to be "bullying" Does it include being bullied while giving report to the next shift? When I need to know something important about a patient, I don't ask another nurse, I go look it up in the chart because it's more reliable, I mean you wouldn't ask another nurse which IV fluids are compatible because you would look it up, right?....but I don't know, maybe it's just me.

Posted by: Brandy Reeves | Jul 3, 2009 1:37:55 PM

Lateral violence is a growing problem in healthcare and I'm glad hospitals are being expected to address inappropriate behavior. I still shudder when I recall being bullyed by an experienced nurse just a few months into my first job. I wasn't prepared to deal with her behavior. Now there are programs that can help nurses develop postive strategies for responding to disruptive behavior. I just signed up to attend a workshop being held in June by the Center for American Nurses. (www.CenterforAmericanNurses.org) I am hopeful we can eliminate nurse bullying and other disruptive behaviors.

Posted by: Virginia | May 1, 2009 4:04:20 PM

I have just had to leave a program in my final semester because I dared to file a formal complaint against an instructor who was both physically and verbally abusive towards me. All I wanted was to be shifted to another clinical with a different instructor. Instead, basically, although I was a dean's list student, I was told that my only options were to withdraw my complaint and go back for more of the same from the same instructor, or to leave the program. I am still dumbfounded. I followed the correct proceedure for filing a complaint to the letter in the student handbook, and this is what I got.

Posted by: jayn | Apr 19, 2009 4:53:06 PM

I was a new grad three years ago, received acceptance into a specialty program, and unwittingly accepted. Since then these specialty nurses and my regulatory body have been harassing me. Thousands of dollars spent as bitter old nurses lied about me to keep me out of their precious "specialty area". They didn't care if it cost me a career. Nor did my regulatory body. They are still playing games and bullying me, and they are protected from any legislation. I am embarassed for the profession. As an adult I changed careers to help seniors, now I need to know how to get away from constant bulling and harassment.

Posted by: Marie | Mar 30, 2009 9:50:34 PM

Looking back on my twenty-plus years in nursing, I would say JCAHO cannot address lateral violence in nursing soon enough. I have been forced to quit my hospice position because of lateral violence so prevasive in my former workplace, that the management level of nursing seems to initiate and encourage it. I was not the first RN to quit with this organization due to personal harrasment by a supervisor, nor will I be the last, but the supervisor remains in her position despite a group of nurses and social workers collectively complaining about the negative behaviors of the particular supervisor. I was singled out and suffered numerous false accusations. Rather than fight, I quit my position because fighting was taking away the good energies I wanted to be able to bring to my patient's homes and bedsides.
JCAHO must bring management in healthcare settings into some strict standard of compliance. Nursing staffing all over the country is suffering severely due this unchecked sickness in our profession.

Posted by: baraco1 | Mar 15, 2009 4:48:44 PM

I have been a nurse for more than 30 years. I am so grateful that JCAHO has stepped in on this issue. As a retired Army Nurse, I assure you that the nurse-nurse bullying is far worst in the Army. In my many years in the Army, I can honestly say that Doctors who harass RNs are few and far between. While I miss the low level of the latter type of bullying, the former was very painful and unhealthy.

In the Active Army and the Army Reserves, the bullying I experienced (and watched others experience) was usually from superiors, often times racially motivated, envy motivated, or just because they were mean spirited AND it was acceptable.

Unfortunately, excellent, caring nurses took off their rank and went home, some suffered mental and physical health consequences. Some turned to alcohol etc.

In the civilian sector, some nurses move from job to job because they feel helpless. Bullying from both Doctors and other nurses is pervasive! If a nurse speaks up about harrassment/bullying they are labeled trouble makers and suffer the consequence of worst treatment or getting terminated. In fact in many hospitals, nurses are fired because a physician does not "like" them.

Frankly, I am embarrassed that nursing is this way. The only way this is going to change is to legislate standards and have whistleblower protection.


Keep in mind that the nurse that comes in your room or your loved one's room could be stressed, depressed and possibly angry about the way they are being treated. This could easily result in maltreatment, omission, errors, apathy...and the list goes on.


I pray I live to see this issue improve.

Posted by: Retired Army Nurse | Feb 28, 2009 1:02:00 AM

I have been a nurse for more than 30 years. I am so grateful that JCAHO has stepped in on this issue. As a retired Army Nurse, I assure you that the nurse-nurse bullying is far worst in the Army. In my many years in the Army, I can honestly say that Doctors who harass RNs are few and far between. While I miss the low level of the latter type of bullying, the former was very painful and unhealthy.

In the Active Army and the Army Reserves, the bullying I experienced (and watched others experience) was usually from superiors, often times racially motivated, envy motivated, or just because they were mean spirited AND it was acceptable.

Unfortunately, excellent, caring nurses took off their rank and went home, some suffered mental and physical health consequences. Some turned to alcohol etc.

In the civilian sector, some nurses move from job to job because they feel helpless. Bullying from both Doctors and other nurses is pervasive! If a nurse speaks up about harrassment/bullying they are labeled trouble makers and suffer the consequence of worst treatment or getting terminated. In fact in many hospitals, nurses are fired because a physician does not "like" them.

Frankly, I am embarrassed that nursing is this way. The only way this is going to change is to legislate standards and have whistleblower protection.


Keep in mind that the nurse that comes in your room or your loved one's room could be stressed, depressed and possibly angry about the way they are being treated. This could easily result in maltreatment, omission, errors, apathy...and the list goes on.


I pray I live to see this issue improve.

Posted by: Retired Army Nurse | Feb 28, 2009 1:01:59 AM

I have been a nurse since 1968, having graduated from a Bachelor's program in which I was severely bullied by an instructor during my sophomore year. She was cruel and intimidating. She told me I wasn't cut out to be a nurse! Since that time, with two exceptions, I can honestly say that in EVERY nursing job I've had since I graduated, I HAVE BEEN BULLIED. I could describe numerous incidents that are burned in my memory and still cause me to shudder and doubt my abilities.The worst experiences were in acute care, where CNA's and other RN's made my life miserable. They were much worse than the MD's. Sadly, I just don't want to ever work in acute care ~ this is the primary reason why.

Posted by: Becky | Feb 3, 2009 12:01:42 PM

I am distressed by the bullying by our manager on my floor in the hospital. She writes people up constantly; she is verbally aggressive and harrasses particular employees. The worst part is that since she came, no one in upper management beleives us, and think we are resisting following the rules. Additionally, she denies and twists the abusive things she says, and HR and others will do nothing. Where do I go from here. I am so distressed I am quitting a job I loved.

Posted by: leslie | Dec 16, 2008 3:42:16 AM

I strongly believe that all of casual nurses or new nurses who suffer silently the bullying must end with a professionnal fight.

I will try to take to the higher level and make sure that those nurses who try to bully us must be out the door and not us.

I will post all the steps necessary to win the case and to ease our victim pain.

Posted by: Nguyen | Nov 25, 2008 9:56:04 AM

I would like to know what if the "Bullying" is coming from the CEO of the Hospital? Basically our Dept. was told that now that we answer to her that things will go the way that she says or we can leave. Even though the majority of the staff have more experience in our field than she does and she won't listen to suggestions. We are told that we are salary and we will work till the work is done, prioritizing isn't the logical thing to do. We are on the road all the time working with Drs., DCP's, Community ECF's. Yet we can't be late for a mtg. we will get a mark against us. Isn't there enough stress in this world that when we go to work, we can't just take a deep breath and say let's get this done together and treat each other the way that we, ourselves, want to be treated. Why do people have to"Bully" anybody?
I too Love my job, or at least I did! For the first 4-5 yrs I use to tell my boss every week I Love my job. Now 9yrs into it I have a job, that's it. People should love their jobs. Employers should make it their responsibilty to keep their employees happy {within reason of course}. One of my last statements to my clients before I leave is always, "Is there anything else I can help you with today". Wow!! What a concept!! Can I help you!!! If everyone would just stop to think why did we go into the medical field to begin with, I know I did because I wanted to help people. Than maybe we could take that deep breath and think before you bully anyone. That's just plan ole unprofessional and rude!
As for the Nurses that do beside nursing I commend you!! In the 30+ yrs that I have been a Nurse I have seen drastic changes in the medical field and I don't think I would ever go back to that arena. As for being bullied on the floors, you folks have enough bullying from the patients and there families that if a Dr or a fellow employee is out of line Administration should support you and handle it. And I think that if the Joint Commision has to set guidelines for this then so be it. No one should have to feel threatened or bullied at work, that's your lifeline.

Posted by: famc | Oct 26, 2008 11:21:55 PM

i'm a new grad and was on the floor 2 days when they wanted me to take 2 patients ... on my own. well, during the first two days my preceptor wasn't precepting and i mentioned to her i wanted more of a team approach of teaching than me doing things on my own while she was in other rooms doing things on her own. so this third day i said i can't believe this is happening. no one wanted to make changes and said wait til monday to talk to the dept mgr (today was sat. and i would have had to work sat and sun / 12 hours on my own). i couldn't allow this to happen. i said I QUIT. while in the locker room changing, overnight nurses that were leaving asked me why and i laid it out, fact by fact about orientation. they said it sometimes goes that way. monday i heard from my old boss that they weren't going to file with jcaho about my disruptive behavior. i said thank you.

why was i being threatened now?

i already quit and i was the one being put in a unsafe situation to begin with. what about patient care and safety and my license?

Posted by: melanie | Oct 8, 2008 1:15:20 AM

I gave this some thought. Actually, thoughts just came to me today while working out. I am a semi retired nurse. I am 62, I saw changes coming with attitudes, like a two year degree vs. a four degree. Rather than learn from older nurses, it is an attitude of I can do it or I am better at it. I find today young nurses do not have bed side manner. Perhaps it is the insurance companies, physicians, etc. and medicine has advanced significantly, more mechanical than bedside.

I did for 18 years visiting nurse, concentration on some long term who lived either alone or with a family member, but, heavy in hospice.

When, I did return to a nursing home or hospital, I found that the younger personnel do not respect age, nor experience. They know it all, they are the time out generation, full of image boosting talk while growing up, as opposed to my generation, we developed slowly and respected what our elders said, or pondered
it.

Sandi
Massachusetts

Posted by: sandi_ruscetta@yahoo.com | Oct 1, 2008 5:48:36 PM

Is there a support group anywhere which supports the girls who may have something to help each other to get by.

Posted by: L:Isa Kehrt | Sep 27, 2008 7:46:45 PM

Is there a support group anywhere which supports the girls who may have something to help each other to get by.

Posted by: L:Isa Kehrt | Sep 27, 2008 7:46:43 PM

Every hospital and care setting I have worked in two states has had the behaviors discussed in this blog. I have seen it from a CNA and RN prespective in Med Surg, ED, and now home Health. I have seen managers do it to whole staffs and I have seen nurses picked out as scapegoats for a shift crew. I have seen the silent treatment, the horrible demented max assist overload, the failure to volunteer information, always taking last lunch. Any kind of b**chy meanness possible amongst alleged civilized intelligent people. What gets me is this, If nurses are so blind to thier own negative crap how can they spot when a patient is having a problem?
The fact that the problem is universal across settings and goes up and down ward on the power scale shows the severity of the problem. Having the feds involved does draw attention to the problem but it does not resolve issues. How long has the government been studying nursing staff shortages? There is a clear solution to poor staffing but it has it been fixed in the 20 yrs that the solution has been known. Why would horizonital violence be any different? It has to be acknowledged that the violence is caused by people feeling powerless and out of control and attempting to protect a sense of self even if it is dangerous, unprofessional or wretched inhumane to a fellow caregiving nurse. You can't assume abuser will "mistreat" patient's because at a sub conscious level the insecure nurse knows she is dominant, thus not threatened, by the dependent patient.

Posted by: sdion | Sep 27, 2008 1:29:56 AM

The comments to this entry are closed.