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From the Top Down: How Leadership Can Diminish Workplace Bullying
EXPERIENCE TALKS
FROM THE TOP DOWN: HOW LEADERSHIP CAN DIMINISH WORKPLACE BULLYING Author: Nina Ng, MSN, RN, TNCC, Staten Island, NY Section Editors: Cindy Lefton, PhD, RN, and Jennifer Williams, PhD, RN, ACNS-BC
“
lthough research and evidence-based practice are critical for the advancement of emergency nursing, one’s experiences and how one has successfully implemented change helps the profession grow and increases the health of our chaotic work environment. Please keep sending us your pearls of wisdom.” JW and CL.
A
The worst parts of ourselves are often hidden from our own view. In health care, bullying and workplace violence exist in a multitude of ways: nurse to nurse, patient to staff, staff to patient, staff “eating their young,” and, essentially, one human being to another. Based on my own experiences as a clinical nurse and nurse manager, bullying is detrimental to mental well-being and can lead to sadness, helplessness, embarrassment, a decreased sense of self-worth, and fear. I have witnessed the buildup of psychological pain and have seen how it can manifest in anger, apathy, disengagement, compassion fatigue, and a desire to bully others. In addition to the impact on individuals, these negative interactions can damage the overarching spirit of a team. As a nurse leader, I have devoted considerable time and effort toward understanding the reasons behind bullying and have searched for ways to eradicate workplace violence. A good start is talking about it and creating a space in which a team can have open and candid discussions. My development as a leader has taught me that establishment of a safe environment and encouragement of group communication is vital. It is easy to say that there is a zero-tolerance policy or offer strict consequences for these behaviors, but intervention should not end there. Efforts focused on decreasing bullying behaviors involve “diving in” to explore the underlying causes associated with these Nina Ng is Assistant Director, Northwell Health, Great Neck, NY. The opinions expressed here are those of the respondents and should not be construed as the official position of the institution, ENA, or the journal. For correspondence write: Nina Ng, MSN, RN, TCC, 67 Watchogue Road, Staten Island, NY 10314.; E-mail: [email protected]. J Emerg Nurs 2017;43:586-7. 0099-1767 Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2017.07.011
586
JOURNAL OF EMERGENCY NURSING
actions as well as consistently helping staff connect the dots between these behaviors and how they affect the culture of a unit. In other words, bullying cannot be resolved merely by announcing that it should not exist, and corrective action alone does not make workplace violence disappear. A series of team meetings I once conducted led to astonishing results. As the leader of a busy New York City emergency department where workplace violence was prevalent, I felt a sense of urgency to tackle bullying in a way that was different from traditional methods. Understanding that meaningful and sustainable change often takes time, I scheduled team huddles every few weeks and purposefully named them, “Attitudes and Behaviors.” Some found that title to be too strong, and I sensed that part of human nature is fear of uncomfortable or seemingly confrontational topics. I recognized that efforts associated with eradicating bullying behaviors must involve the experience of discomfort by staff as a means of acknowledging that these actions had become a part of our culture. In these huddles, attendance was never lacking, which proved to me that my team was interested in hearing more, and staff members were invested in finding ways to mitigate a well-known problem. Initially, I found it difficult to engage the group in discussion. I often walked away from these huddles wondering if I was going to achieve any success. Committed to the cause, I remained persistent and kept pulling us together in a room, asking tough questions, and waiting for nurses, technicians, unit assistants, and other staff members to speak up, no matter how intense the silence became. Finally, a breakthrough occurred when a brave nurse spoke up and began to use herself as an example. This seasoned nurse acknowledged how her behavior could be perceived as aggressive and she courageously revealed to the group personal details of her rough upbringing. This candid discussion shed light on her behavior. She spoke with unrestrained emotion and allowed herself to be vulnerable to her peers. In the moment, the heavy presence of tension suddenly lifted and evaporated as the air in the room cleared; we found a way to value one another as human beings. A wholehearted discussion followed, and the experience connected us in a way that I had never felt in any meeting before. Most importantly, this nurse shared with
VOLUME 43 • ISSUE 6
November 2017
Ng/EXPERIENCE TALKS
the group how she was actively working on herself to improve how she was perceived by others and explained how she had been spending her time serving as a mentor to others who struggled with similar challenges. This nurse was in the process of developing an increased sense of self-awareness and going through a transformation. After that meeting, staff members gave me feedback on how they felt a refreshing difference on the unit that day, and many felt an aura of genuine efforts to display kindness to each other, including those who were usually more reserved when it came to displaying collegial affection. One nurse commented that the team meeting felt therapeutic and said that she would like to have more frequent meetings. People on the unit who felt that they had been victims of bullying reached out to me with gratitude, thankful that a forum had been created for the team to face these issues head-on. As an optimist, I believe most health care providers are not intentionally seeking to inflict harm upon others. This optimism does not imply that a team should tolerate negative attitudes or behaviors. Instead, this positive perspective embraces the idea that behavior and mindsets can change. My experiences have taught me that there is much value in—and necessity for—creating an environment in which teams learn how to manage conflict by discussing sensitive issues openly. Team members need to feel safe enough to express themselves with candor and seek forums in which they may speak openly about stressors. As a result, such discussions can help increase one’s self-awareness regarding the impact of his or her actions. Candid discussions provide opportunities for health care teams to discover and interpret how their attitudes and behaviors can have impact on others in the workplace and
November 2017
VOLUME 43 • ISSUE 6
provide leaders with insight into a person’s willingness to change. Meaningful conversations that aim to instill lasting change can be both mentally taxing and liberating at the same time. It takes a great deal of effort and energy to change attitudes and behaviors. Health care leaders have the responsibility to bring these topics back to the surface, to repeatedly dissect the existing interactions that occur within a team, and to develop individualized plans that actualize purposeful outcomes. The takeaway is to stay persistent with the cause and find creative ways to encourage your team to bond. One does not need to have an administrative title to do this; any person is capable of influencing his or her environment in a positive way. Bullying does not necessarily need to be viewed as something that must be “fixed” with a “heavy stick” but rather a challenging aspect of human nature that involves helping staff recognize how others perceive their attitudes and actions along with how their behaviors influence their environment. Once addressed and resolved, negative human emotions are released, and bonds are strengthened. The services we provide to our patients are challenging and endless; it is only fair that we develop the strength and courage to shape our world into a harmonious one. The end results include trust, forgiveness, compassion, satisfaction, and creation of a more peaceful environment for all to appreciate and enjoy.
Submissions to this column are encouraged and may be sent to Cindy Lefton, PhD, RN [email protected] Jennifer Williams, PhD, RN, ACNS-BC, CCRN, CNS [email protected]
WWW.JENONLINE.ORG
587
FROM THE TOP DOWN: HOW LEADERSHIP CAN DIMINISH WORKPLACE BULLYING Author: Nina Ng, MSN, RN, TNCC, Staten Island, NY Section Editors: Cindy Lefton, PhD, RN, and Jennifer Williams, PhD, RN, ACNS-BC
“
lthough research and evidence-based practice are critical for the advancement of emergency nursing, one’s experiences and how one has successfully implemented change helps the profession grow and increases the health of our chaotic work environment. Please keep sending us your pearls of wisdom.” JW and CL.
A
The worst parts of ourselves are often hidden from our own view. In health care, bullying and workplace violence exist in a multitude of ways: nurse to nurse, patient to staff, staff to patient, staff “eating their young,” and, essentially, one human being to another. Based on my own experiences as a clinical nurse and nurse manager, bullying is detrimental to mental well-being and can lead to sadness, helplessness, embarrassment, a decreased sense of self-worth, and fear. I have witnessed the buildup of psychological pain and have seen how it can manifest in anger, apathy, disengagement, compassion fatigue, and a desire to bully others. In addition to the impact on individuals, these negative interactions can damage the overarching spirit of a team. As a nurse leader, I have devoted considerable time and effort toward understanding the reasons behind bullying and have searched for ways to eradicate workplace violence. A good start is talking about it and creating a space in which a team can have open and candid discussions. My development as a leader has taught me that establishment of a safe environment and encouragement of group communication is vital. It is easy to say that there is a zero-tolerance policy or offer strict consequences for these behaviors, but intervention should not end there. Efforts focused on decreasing bullying behaviors involve “diving in” to explore the underlying causes associated with these Nina Ng is Assistant Director, Northwell Health, Great Neck, NY. The opinions expressed here are those of the respondents and should not be construed as the official position of the institution, ENA, or the journal. For correspondence write: Nina Ng, MSN, RN, TCC, 67 Watchogue Road, Staten Island, NY 10314.; E-mail: [email protected]. J Emerg Nurs 2017;43:586-7. 0099-1767 Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2017.07.011
586
JOURNAL OF EMERGENCY NURSING
actions as well as consistently helping staff connect the dots between these behaviors and how they affect the culture of a unit. In other words, bullying cannot be resolved merely by announcing that it should not exist, and corrective action alone does not make workplace violence disappear. A series of team meetings I once conducted led to astonishing results. As the leader of a busy New York City emergency department where workplace violence was prevalent, I felt a sense of urgency to tackle bullying in a way that was different from traditional methods. Understanding that meaningful and sustainable change often takes time, I scheduled team huddles every few weeks and purposefully named them, “Attitudes and Behaviors.” Some found that title to be too strong, and I sensed that part of human nature is fear of uncomfortable or seemingly confrontational topics. I recognized that efforts associated with eradicating bullying behaviors must involve the experience of discomfort by staff as a means of acknowledging that these actions had become a part of our culture. In these huddles, attendance was never lacking, which proved to me that my team was interested in hearing more, and staff members were invested in finding ways to mitigate a well-known problem. Initially, I found it difficult to engage the group in discussion. I often walked away from these huddles wondering if I was going to achieve any success. Committed to the cause, I remained persistent and kept pulling us together in a room, asking tough questions, and waiting for nurses, technicians, unit assistants, and other staff members to speak up, no matter how intense the silence became. Finally, a breakthrough occurred when a brave nurse spoke up and began to use herself as an example. This seasoned nurse acknowledged how her behavior could be perceived as aggressive and she courageously revealed to the group personal details of her rough upbringing. This candid discussion shed light on her behavior. She spoke with unrestrained emotion and allowed herself to be vulnerable to her peers. In the moment, the heavy presence of tension suddenly lifted and evaporated as the air in the room cleared; we found a way to value one another as human beings. A wholehearted discussion followed, and the experience connected us in a way that I had never felt in any meeting before. Most importantly, this nurse shared with
VOLUME 43 • ISSUE 6
November 2017
Ng/EXPERIENCE TALKS
the group how she was actively working on herself to improve how she was perceived by others and explained how she had been spending her time serving as a mentor to others who struggled with similar challenges. This nurse was in the process of developing an increased sense of self-awareness and going through a transformation. After that meeting, staff members gave me feedback on how they felt a refreshing difference on the unit that day, and many felt an aura of genuine efforts to display kindness to each other, including those who were usually more reserved when it came to displaying collegial affection. One nurse commented that the team meeting felt therapeutic and said that she would like to have more frequent meetings. People on the unit who felt that they had been victims of bullying reached out to me with gratitude, thankful that a forum had been created for the team to face these issues head-on. As an optimist, I believe most health care providers are not intentionally seeking to inflict harm upon others. This optimism does not imply that a team should tolerate negative attitudes or behaviors. Instead, this positive perspective embraces the idea that behavior and mindsets can change. My experiences have taught me that there is much value in—and necessity for—creating an environment in which teams learn how to manage conflict by discussing sensitive issues openly. Team members need to feel safe enough to express themselves with candor and seek forums in which they may speak openly about stressors. As a result, such discussions can help increase one’s self-awareness regarding the impact of his or her actions. Candid discussions provide opportunities for health care teams to discover and interpret how their attitudes and behaviors can have impact on others in the workplace and
November 2017
VOLUME 43 • ISSUE 6
provide leaders with insight into a person’s willingness to change. Meaningful conversations that aim to instill lasting change can be both mentally taxing and liberating at the same time. It takes a great deal of effort and energy to change attitudes and behaviors. Health care leaders have the responsibility to bring these topics back to the surface, to repeatedly dissect the existing interactions that occur within a team, and to develop individualized plans that actualize purposeful outcomes. The takeaway is to stay persistent with the cause and find creative ways to encourage your team to bond. One does not need to have an administrative title to do this; any person is capable of influencing his or her environment in a positive way. Bullying does not necessarily need to be viewed as something that must be “fixed” with a “heavy stick” but rather a challenging aspect of human nature that involves helping staff recognize how others perceive their attitudes and actions along with how their behaviors influence their environment. Once addressed and resolved, negative human emotions are released, and bonds are strengthened. The services we provide to our patients are challenging and endless; it is only fair that we develop the strength and courage to shape our world into a harmonious one. The end results include trust, forgiveness, compassion, satisfaction, and creation of a more peaceful environment for all to appreciate and enjoy.
Submissions to this column are encouraged and may be sent to Cindy Lefton, PhD, RN [email protected] Jennifer Williams, PhD, RN, ACNS-BC, CCRN, CNS [email protected]
WWW.JENONLINE.ORG
587