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Tough Conversations on Nurse Bullying Leads to Positive Change

Not to long ago, I had the honor of joining a long list of highly respected speakers at the annual convention of Ambulatory Surgery Center Association in Dallas, TX!  My topic for a breakfast discussion was, “Dealing with Bullying in the Workplace”!  The turnout for this early morning conversation was wonderful!  I was expecting 10-20 ambulatory surgery professionals and over 75 showed up!  The energy in the room was palpable!

It can be scary to hold space for conversations on tough topics like bullying, yet, as an expert facilitator and a nurse I know it is one of the most powerful things we can do to set the stage for change.

But fun?  And Helpful?  Really?

The hour flew by.  People were engaged and participating.  I combine presentation and facilitation skills with brainstorming questions like; “What do bullying behaviors look like in Ambulatory Surgery practices?” and “How does it impact your work?”.

Tentatively, at first, yet surely, folks start to share their experiences.  As one person offers a story about a doctor who humiliates a nurse, soon someone else shares a story about losing valuable staff because of nurse-to-nurse bullying and gradually more and more hands go up.  I race around the room with a microphone, inviting, clarifying, occasionally a gentle challenge, and at times offering my own expertise in group dynamics, communication skills, leadership and/or emotional intelligence.

I ask, “Are these stories familiar?”   Many heads around the room are nodding and I can hear voices coming from all different directions:

“Yes, YES!”

“I received an anonymous letter at home that was very derogatory.”

“We all have these experiences!”

“One of my nurses told the surgeon, after he repeatedly insulted her, that she did not want to work with a physician who was about to perform surgery on the wrong shoulder.”

“I’m still in my job because I shut-up.  The two nurses before me spoke up.”

“It has always been like this!”

“I’ve been trying to discipline a nurse for repeated bullying, but the administration won’t let me fire her.”

Our patient satisfaction surveys are very positive, but the dynamics among staff and surgeons is very disturbing.”

We are all looking at the elephant in the room.  And we are looking at it together.   Some are frustrated or angry.  Some may feel threatened or despairing.  My colleagues are engaged and our conversation is real.  Some discomfort seems unavoidable if we are going to be more aware and accountable about the many faces and harms that bullying causes in our healthcare systems.  As a facilitator, I am helping to navigate a ship through difficult waters.  At first it is tricky to get them talking and now that they are, it is tricky to keep the flow of conversation in a positive direction.   I want to ensure a safe space and also that we keep moving.  Partly because of time constraints, but more importantly, I believe it is critical to both honor these feelings and to NOT get stuck in them.

The next questions go something like this; “How do these behaviors impact the work you are doing or trying to do?”  “How do they impact you?” “Your team?”

“It compromises safety!”

“A huge waste of time and money.  As a manager, I spend 1-2 hours every day dealing with one person!”

“There is so much tension coming to work every day.”

“The cost of losing staff.”

“I think people get physically sick.”

“The first year I was practicing I went home every day, crying and people would tell me this is what you have to go through if you are going to make it as a nurse.”

Now we have a large group of highly skilled professionals talking and listening about the toll that bullying takes.   On patients, staff, teams and systems.  I am compelled to validate the difficult experiences that so many have had.  Just one minute of the hour long workshop to say as a colleague; “It wasn’t ok.  I’m sorry that you had that experience.  You didn’t deserve it” Or as organizational leaders; “We are sorry and we know that has been the culture for a long time.  AND now we are committed to creating positive and safe workplaces”!

This is an incredibly powerful moment! And one that I strongly believe is necessary for effective change agent work.  Metaphorically, I am bowing to the elephant in the room and gently, even lovingly, swooping a collar on him/her and leading him/her to the door.  We have a lot of work to do to get that elephant out, but the energy is shifting.  Our ship is moving out of a turbulent eddy that has held it i.e.  us back for years and years and years.  There is still rough water, but we are unstuck!

It is time to ask final questions; those that point us into a healing direction.

I ask, “What does respectful communication and what do respectful work relationships look like in your workplace?  What ideas do you have?”

“We’re listening to each other.”

“We are more tolerant of our differences.”

“There is more accountability and a sense of teamwork.”

“I look forward to coming to work.”

“We can learn from conflict.”

“My staff is receptive to coaching.”

“There are no mixed messages and no double standards.”

“We speak up if something is bothering us and we are heard.”

Can you feel how this one-hour experience sets the stage for productive work?  How inherent in the process is an element of trust-building?  Next steps involve difficult work.  Culture change does.  Setting new norms, continuing to build trust, provide training in giving and receiving feedback, coaching, opportunities to practice new skills and ultimately discipline are all part of the journey.  Yet resistance has melted for many and the informal power of the old way of being is greatly diminished. There is a readiness, enthusiasm and commitment towards safer, kinder and more cost-effective care and healthier careers!  I love helping nurses and organizations be more effective.  Please call if you’d like to schedule one of these tough yet fun and productive conversations with your staff! beth@bethboynton.com 603-319-8293

Guest post by Beth Boynton RN, MS

This post appeared originally in Confident Voices blog by Beth Boynton.

Beth Boynton, RN, MS, is a nurse consultant, author, and teacher specializing in communication and collaboration among healthcare professionals and within organizations. She offers interactive workshops, leadership coaching, a ‘whole systems’ approach for culture change efforts, and a new method for building ‘people skills’ called ‘Medical Improv’. She has recently completed her second book, a core text called: Successful Nurse Communication: Safe Care, Healthy Workplaces, and Rewarding Careers which is scheduled to be published by F.A. Davis Publishing Co. Spring 2015. She writes about related issues at, “Confident Voices in Healthcare” blog. Her video, “Interruption Awareness: A Nursing Minute for Patient Safety,” and blog have drawn audiences from all over the world. She is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. She has one grown son who is works in India, loves improv, Zumba dancing, walking, and swimming, and lives in Portsmouth, NH.

You may view Beth's online contiuing education course - 4 Essential Stratefies that Promote Patient Safety. This is a 2 contact hour course that features Beth in 10 short video's designed to engage and teach the student.  This instructional continuing education course is designed for nurses who are in direct care or middle management positions in hospitals; long-term care facilities, and other frontline in- and out-patient practice settings.  Despite 15 years of national focus on improving patient safety outcomes, we continue to have staggering statistics involving preventable deaths, illnesses, and injuries that are due to medical errors. And because communication breakdowns and associated problems with inter-professional relationships have long been major contributors to these alarming problems it is imperative for nurses to develop skills and promote positive interpersonal dynamics. Respectful interactions and effective communication seem simple on paper, yet successful efforts to practice them in the field remain elusive.  In this course, students will examine patient safety statistics and root cause analysis data in order to understand the scope of the problem and how persistent issues with communication and human dynamics are interfering with providing safe care.  This foundation will provide the incentive to commit to exploring and practicing communication strategies that will help to solve them. A basic knowledge of assertiveness, listening, and emotional intelligence is required as students take a ‘deeper dive’ with Beth Boynton, RN, MS to develop their abilities to:  set limits, delegate tasks, and give and receive constructive feedback.

Pedagogy also offers online contiuing education on the topic of bullying in healthcare. Healthcare Bullying Solutions may be purchased for individual use or provided to an entire facility or organization. Please call for our special pricing for institutions desiring to provide this education for all staff at 903-871-2150 or email us at sales@pedagogy-inc.com .

Healthcare Bullying Solutions online course author Donna Krasowski offers a wonderful tool to assist in the determination if bullying may be an issue in your place of employment, follow the link to view the Workplace Bullying Quiz.

Posted: 4/13/2015 2:47:30 PM
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