SELF DESTRUCTIVE: "Nurses eat their own?"

In 2021, a story echoed within the nursing community in Nunavut that a nurse working in one of the remote and isolated communities in that territory in Canada attempted to commit suicide. This was while the nurse was working in one of the nursing stations. There were several accounts pinpointing the reasons for the nurse's attempted suicide, among those was bullying. Why should bullying almost cost a life of a nurse?

Why should nurses harass their own instead of nurturing them? Why should nurses that care for their patients be mean to their counterparts?

" Nurses eat their own? "

“Nurses eat their own” is a phrase coined in the 1980s and is frequently seen in the nursing literature dedicated to bullying or harassment in the workplace. The Registered Nurses Association of Ontario (RNAO) defines

bullying as “Repeated and persistent behaviours that can include social isolation, creating or spreading rumours, engaging in excessive or unjustified criticism, intimidating a person, physically abusing or threatening abuse, and withholding job responsibilities” (RNAO 2019). Workplace bullying or harassment happens in other professions and is not unique to nursing. However, how prevalent is bullying in the field of nursing in Canada?

The Canadian Federation of Nurses Union (CFNU) reports that 61% of Nurses admitted to being victims of bullying in the workplace (CFNU 2017). Additionally, a study conducted in 2010 in Ontario by Dr. Mallette indicated that 95% of the participants had witnessed lateral violence and 71% had been targets of bullying. This picture is daunting for the profession that embraces caring, empathy, compassion, respect, trust and human dignity as its core values.

Assessing and diagnosing bullying in nursing

The signs and symptoms of bullying can be obvious or subtle, abrupt or gradual. Nurses are prone to bullying by managers, the medical staff, fellow nurses and patients. The relationship between management and the nursing team can sometimes be challenging. Some managers lead their units with an “iron fist”. For example, tactics such as intimidation, nepotism, extreme micromanagement, unfair assignments or exclusion are used as part of their management strategy (Cole and Caroline 2019). This management style

creates alienation, decreased morale, poor teamwork and absenteeism, which can negatively affect the quality of care nurses provide for self and patients.

Moreover, the medical and the nursing staff do not always have the most collegial relationship. Nurses sometimes fear calling or working with doctors that they find to be disrespectful or condescending. In some instances, nurses are meant to feel that “their intelligence, experience and ability to care for patients are in question” (Katz 2014). In some nursing units, the on-call doctor or the doctor on duty determines a good day. Many nurses report high stress levels and anxiety when dealing with doctors that they find challenging

to work during the same shift.

In addition, nurse-on-nurse bullying is said to be pervasive. It goes beyond gender, age, race, experience, education attainment and work status. The American Nurses Association (2015) reports that some senior nurses with more expertise and experience have a “super nurse” persona with an “I know it all” attitude. Thus, they might knowingly or unknowingly display a superiority complex and often act in a condescending manner to their peers. Likewise, younger nurses can be critical of the appearance and physical limitations

of older nurses. Also, Registered Nurses may maltreat or look down on Licensed Practical Nurses; indeterminate nursing staff are reported to have discriminated against agency nurses.

The divide and discriminating factors are vast. Furthermore, Cole and Caroline (2019) purported that there are also factions or “cliquish nurse” using exclusion as a way of practicing aggression, favoritism for some and alienating others. This may generate conflict and mistrust in the workplace.

So, who is the biggest loser with the issue of bullying in nursing?

A toxic nursing work environment dismembers the thread that brings nurses together, which is caring. Bullying is eroding nursing from within. It is contributing to increased absenteeism, nursing shortage, decreased productivity, unsafe patient care, sleep disturbance, substance abuse, anxiety, depression and in some cases suicide. The list of physical and psycho-emotional ailments related to bullying is endless. Nursing shortage has been affecting every province and territory Canada wide leading to an increased burnout rate that may result in decreased quality of patient care. The financial impact of bullying is substantial. According to the CFNU (2017), it is estimated that 17-36 billion dollars is spent yearly to address and deal with the consequences of bullying worldwide.

It begs the question: What should be done in the face of this monstrosity?

Acknowledging that bullying is a systemic issue in the healthcare system is the starting point. Raising awareness, writing policies and providing resources for management and front line staff can help mitigate the issue of bullying. Nurses should remind themselves that self-care and caring for patients should be at the heart of the nursing profession. Nurses should remember that they are better caregivers when they are able to take care of themselves; not feeling guilty when taking breaks, having ample time to enjoy a meal while at work, and including recreation in their routine, such as, exercise, walks, meditation, spa days, social gathering with co-workers, friends and family.

The time has come for nurses to celebrate one another by making the concerted effort of coming together as a unit. CELEBRATE US is designed to meet this goal. It is a blog for nurses to share ideas and resources about the triumphs and best practices suited to the profession of nursing to advance and

empower its members.

References

The Nurse Bullying Epidemic

Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN and Caroline Zelonka, BS (July 2019)

Nurses Association [ANA], (2012). Bullying In the Workplace. Nursing Insider News. Retrieved from http://www.nursingworld.org/HomepageCategory/NursingInsider/Archive_1/2012-NI/Apr-2012-NI/ANA-Bullying-in-the-Workplace-Publication.html Katz, K. (2014). Bullying in Nursing: Why Nurses Eat Their Young. Registered Nurses Association of Ontario (RNAO).

Best Practice Guidelines: Preventing Violence, Harassment and Bullying Against Health Workers, Second Edition (July 2019).

The Canadian Federation of Nurses Union (CFNU): Enough is enough, Putting a Stop to Violence in the Healthcare Sector (2017)

“They can crush you”: Nursing students’ experiences of bullying and the role of faculty L. Michelle Seibel∗ , Florriann Carissa Fehr School of Nursing, Thompson Rivers University, Kamloops, BC, Canada Received: October 17, 2017 Accepted: December 16, 2017 Online Published: January 10, 2018

“Nurses Eat Their Young”: A Novel Bully

ing Educational Program for Student Nurses, Gordon L. Gillespie,

Paula L. Grubb, Kathryn Brown, Maura C. Boesch,and Deborah Ulrich (2017)

Relationships Between Nurses and Physicians Matter. Sandra L. Siedlecki, PhD, RN, CNS and Eric D. Hixson, PhD, MBA (2015)

Nurse Manager Bullying and What to Do About It. Written by Zach Smith, BSN, RN (2019)

American Nurses Association. Position Statement: Incivility, Bullying, and Workplace Violence. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/. Published July 22, 2015. Accessed March 2, 2019.