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Reducing Bullying in the Nursing Environment


Bullying is any repeated and systemic behavior that needs to victimise, humiliate, undermine or threaten towards others, which can impact on physical and internal well-being. Bullying has been considered as unaccepted workplace behavior that affects occupational health insurance and safety, and really should not be tolerate in virtually any form (Ref). This paper will provide an analytical discussion of the relevant literature of bulling in medical environment. Rationale respect to the necessity of changing management plan will be discussed. The program will utilise Lewin's three steps of change theory as a guide to modify the specific phase of change. In addition, it will dwelling address the strategies for evaluating the plan outcomes. Finally, this paper will conclude insightfully highlighting main concerns about lowering bullying behaviour in nursing environment.

Literature review

Workplace bullying exists in every professional. Especially, bullying in medical care environment has been internationally recognized and explored. 70% of US signed up nurses who participant in a study reported being bullied at the job. 87% of Turkish nurses explained being bullied in another nursing study (Ref-Barbara S. Broome). In addition, UK healthcare reported that recent data revealed 85% of nurses have been involved in bullying or observed a bullying (Ref-Malcolm A. Lewis) and (Ref-Sharon J. Stagg) found 40% of participants never reported bullying in their review. (Ref-A typology of bullying behaviours) declare that due to lack of descriptive standard to identify bullying behaviours, which causes less of effective interventions for lowering bullying behaviours. In addition, the lack of id of bullying behaviours, bullying works may be commonly interpreted as 'office plans' or 'personality differences'.

The implications of bullying serves are seriously effect on many aspects, such as nurses, organizations and patients. Matching to (Ref-Michelle Cleary), the current working environment in healthcare setting is focused to keep safe procedures at the meantime also to achieve effectiveness results in day-to-day patients' care management. Therefore, under this pressure, it is much more likely to create a blaming environment. Nurses who work in a environment of bullying may lead to job dissatisfaction, which, in a manner that nurses may avoid come to work or call suffering leave to avoid facing bullies, and present low efficiency in the wards. The bulling works may impact on both physical and mental wellbeing, that your frequent final results for bullying are head pain, stress, irritability, stress, sleep disturbance, abnormal worry, impaired sociable skills, depression, tiredness, loss of attentiveness, helplessness, psychosomatic problems, and post-traumatic stress disorder (Ref-Michelle Cleary). Furthermore, the bullied employees from (Ref-LARS JOHAN HAUGE)'s study communicate that they feel more role ambiguity and issues in the working environment, therefore, they may have less social contact and talk to colleagues that leads to poor job control and poor management. (Ref-Terri Townsend) areas that up to 70% of bullied nurses leave the job, 60% of new RNs leave their first job in 6 months and another of new graduate nurses think they choose the wrong job. (Ref-Terri Townsend) also bring in a term - 'survivor syndrome', this means bullied nurses would either to give up the job to find another healthier work environment or adapt to the bullying behaviours as part of the culture and become a bully or bystander. If the nurses leave this professional because of this of bullying, the business has to spend additional money for recruitment and re-orientation for new nurses to displace the position. Furthermore, caused by frequent nursing staff turnover the client satisfaction will reduce and patients may well not get continuous health care which may impact on patients' basic safety issues (Ref-Michelle Cleary).

(Ref- John S. Murray) expresses that the most typical reason of nurses may bully others is the need of being in charge of everything in the task environment. (Ref- Barbara S. Broome) also claims these bullies are narcissistic. Their personality characterized as handling and manipulative, which means that they like to dominate in interpersonal relationships. These people are self-centred that signifies low empathy, and they normally do not feel guilt over enough time by bullying others. Another point of view from (Ref- Work area bullying in medical), they imagine the educational system foster a opinion that the dominate group (normally are senior staffs) is superior and the oppressed group (normally are new staffs) is inferior, therefore, the second-rate has to have the demand from the superior. (Ref- John S. Murray) also highlights that the organization may connive the bullying behaviours in some cases, because of the bullies are senior professionals or staffs. The bullies are guarded instead of the victims, which includes prompted the bullying behaviours existing in the medical environment.

Many studies have suggested that the business has to establish zero tolerance insurance plan and legislation to reduce bullying behaviours in medical care options (Ref-John S. Murray, Barbara S. Broome, Workplace bullying in nursing). (Ref- Barbara S. Broome) claim that education will help nurses to identify the bullies and bullying behaviours and offer ways of eliminate bullying, in the mean time, they state that education on bullying shouldn't only be provided in work place but also be implemented in colleges and continuing education program that empower new graduates to recognize bullying behaviours. In addition, Hutchinson (2009) claims the current methods to bullying are remedial, corrective, regulatory and restorative. Remedial and corrective strategies are give attention to individual aspect, to provide counselling to the victim, to mediate between perpetrator and focus on, and to inform and alter the perpetrator's behaviours. Regulatory and restorative strategies are focus on organizational aspect, to provide prohibitive statements about bullying and also to make the perpetrator to make amends (Hutchinson 2009). These strategies tend to be concentrate on punishing and blaming the perpetrator that has shown ineffectiveness on reduced amount of bullying. Hutchinson (2009) proposes another strategy called 'shared responsibility: a restorative approach to bullying', which will not concentrate on criticising the perpetrator but make the bullying behaviours at the centre. Ref advise that two functions and their followers need to get together to discuss the bullying situation, show the concern, talk about the perfect solution is of what can do to correct the injury and what you can do to prevent bullying behaviours in the future. It's important to learn forgiveness and create a non-blaming and non-judgemental working environment (Hutchinson 2009).

Rationale for plan

The reason to fast the change management plan is several problems from private staffs that they feel being bullied by verbal humiliated, given more workload or hidden information from other staffs, which they have indicated their experience like:

'My preceptor rolled her eye and looked at me like I got stupid every time I asked her a question. I finally quit asking. Doesn't she realize I've only been a nurse for 3 weeks?' (Ref- Terri Townsend)

'Our new director didn't like me from the start. Within a month, she was assigning me increasingly more extra responsibilities until I couldn't have them all done. WHILE I tried to talk to her about my workload, she said I will be able to manage it because I had been the main one with the master's degree. Later she terminated me, proclaiming I didn't meet our department's objectives, even though I had formed several complimentary characters from patients and other professionals. ' (Ref- Terri Townsend)

In addition, in those problems, some have stated that they don't feel comfortable to work with certain people, thus, they called ill leave, which includes alerted the management that the amount of attention has been lowered scheduled to patients dissatisfaction and shortage of nursing staffs in the ward that cannot provide effective medical care. The medical co-ordinator from the ward has stated that she's to call more organization nurses to replace the standard staffs, whereas, this ward has almost reached the organization budget.

If nurse has resigned from the center because of this of bullying, this may cause financial burden to the business. The organization has to pay for recruitment, training parts and orientation for new nurses, which leads roughly $15, 000 immediately extra cost per nurse (Ref- Reiter).

Therefore, the rationale for the change management plan would be decrease the event of bullying, increase bedside nurses retention and increase job satisfaction, which might indirect to boost customer satisfaction as a result of increased level medical care, reduce financial burden to the facility and build-up an improved reputation for this facility in the industry.

Change Management Plan

The change management plan will be led by Lewin's change management model, which include three phrases: unfreeze, change and refreeze.


Identification of what should be changed must be determining in this expression (Ref- Mind Tools). As the private complaints have come to my attention, these problems will be looked at as feedbacks regarding bullying behaviours in this business. An initial survey will be conducted throughout the center to handle staffs' awareness of bullying and if they willing to make a change in the task environment. Another anonymous survey may also be conducted to assemble personal experiences and attitudes from bedside nurses about work related bullying and how they offer with the bullying behaviours. The studies permit the management to comprehend the current perception and relationship of bullying within this corporation and also motivate personnel to be engaged in this changing process.

Another key to improve is to make the organization to use the plan, meaning we must motivate the business to accept the thought of change is necessary for the service and support the change (Ref- Mind Tools). The reviews from the staffs has suggested that the bullying behaviours have influenced the nurses' performance in daily nursing care and attention. Bullying has reduced the nursing staffs' productivity, which leads the quality of care has decreased. Customer satisfaction has decreased as a result form patients cannot obtain adequate level of care, in a way that the organization's reputation would broken. In addition, the nursing coordinator and the individuals resource manager portrayed that high turnover rate in nursing staff, which has immediately made the organization cost extra cash for each replacement of nursing position. Therefore, in order to keep reputation, quality of attention and reduce financial burden, the business must make a change management plan.


The move from unfreeze to change won't happen quickly as staffs and the business has to remember to adapt and admit the new means of working. In such a term, people may have questions about the procedure, such as what is coming and who'll be profit. Clear explanations and genuine approach will help dispel rumours (Ref- Mind Tools). As the medical coordinator and I am going to explain the coming events, that may include growing zero tolerance policy and legislation, providing education lessons to address office bullying and building pathway to survey bullying behaviours. Staffs may be afraid of being punished because of bullying. Therefore, 'shared responsibility: a restorative approach to bullying' from Hutchinson (2009) would be a useful theory to learn. Additionally it is important to inform employees that the program aims at the behaviours, not to criticise or punish people. The results of the change management plan would be create a non blaming nursing culture in this center, which the nursing staffs will have a good working environment and fast them in which to stay the profession. The business will be take advantage of the retention of medical staffs, which reduces costs because of this from medical turnover.

Empowering the involvement is also very important to the changing process. In-services trainings will be kept to provide an chance for employers and employees to have a face-to-face debate of id of bullying and how to deal with bullying, which allow both celebrations being take part in the procedure, promote understanding between each party and promote the move to adjust to the office culture effortlessly (Ref- Mind Tools). Furthermore, to establish a pathway of confirming bullying can help the management immediately respond to any bulling behavior that can develop new experiences and behaviour toward working with bullying.


In this expression, the change has modified to the nursing culture in this facility and we have to develop ways to keep up the potency of change within the facility. For instant, pushing the nurses unite professionals to use the leadership and support their medical staffs in each ward, frequently collecting responses from staffs regarding on bullying experiences and operating workshops or simulations to keep staffs' understanding of bullying is up to date.


The goal of auditing is to market and share guidelines to be able to provide effective good care in daily basis. Developing an auditing is never to criticise poor methods, but by analysing the indegent practices can help nurses know and realize what should go wrong and what cloud do better in patient's health care, in a sense that this will prevent the same event happen again (Ref- Cummins). Therefore, using auditing is the way to assess the outcomes of the change plan. The short term results of audit may show higher rate of bullying, the reason why will be the nursing staffs are more able to identify the bullying serves in the work environment. However, we would expect that the incident rate wouldn't normally rise in the permanent period.

Feedback from medical staffs will ideally provide positive replies regarding to bullying, which can inspire the organization to make use of further education on bullying to improve nursing environment. Survey can also be conducted to accumulate the target data, which suggest that how nursers have the change management plan impacts their daily performances.


Bullying is a popular issue in work area, to make an alteration management plan so it has to bottom part on proof support. When innovate a fresh management, creating the determination is the first step must be contemplated, which means the organization allows the change and the staffs are willing to involve in to the new plan. Start and honest methodology must use to deliver the change as the effective communication can dispel any question or rumour from staffs. First helps from the stockholder will empower people to be engaged. The loan consolidation of the change in today's culture includes ongoing support, monitoring and education programs, which increasing the chance of the change becomes norm.


Reiter, M. , Young, A. , & Adamson, C. (2008). Decrease new graduate

nurse orientation costs by using HESI leave exam results. Journal of

Nursing Supervision, 37(10), 459-463.

http://www. mindtools. com/pages/article/newPPM_94. htm

Cummins, F. (2006). Using auditing to improve and improve practice. Nursing & Residential Care and attention, 8(1), 37-39.

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