Her supervisor dispensed verbal abuse on a regular basis, routinely denying nurses vacation time, belittling their skills, and even setting them up with the wrong instrumentation in surgery.

“Sarah” (not her real name) is one of many nurses across the United States who has worked for a bully disguised as a supervisor.

The same bullies who once terrorized children in the playground now are creating havoc in hospitals.

Bullies aren’t new to the nursing profession, but the time has come when they will no longer be tolerated.

“Many nurses have accepted working in a toxic environment with control-freak physicians and out-of-control supervisors,” said Gary Namie, PhD, a social psychologist and founder of The Workplace Bullying and Trauma Institute (bullyinginstitute.org) in Bellingham, Wash. “Bullies have long ruined their quality of life and driven many good nurses out of
the profession.”

Enter a new crop of Generation X and Y nurses who are speaking out and challenging the concept of bullies in the workplace. “Many older employees thought bullying was an inevitable part of their jobs they were forced to tolerate,” Namie said. “Now, this younger generation is fighting back and refusing to suffer subordination for a paycheck.”

In the case of Sarah, she was among more than 20 nurses who complained to the administration about the bullying they endured on a daily basis from their supervisor. More than 40 physicians substantiated their claims.

“I remember a manager from human resources patting my shoulder and telling me that she’d been in her job for over 20 years and that I had to trust her that this would blow over,” Sarah said. “She assured me that these kinds of situations always blow over. But it didn’t, it only got worse.”

The final straw came when Sarah’s supervisor crossed the line from verbal to physical abuse.

“I was going to the restroom between surgeries when my supervisor approached and screamed at me to go back into the operating room,” Sarah recalled. “She grabbed me by the arm and yelled at me for questioning her authority.”

Sarah ended up being treated for deep nail scratches, bruises, and contusions on her upper and lower arm. Six months after Sarah left, another nurse in the same department was physically assaulted by another nurse manager.

“I really feel the system failed both me and my nurse colleagues,” Sarah said.

Extreme situations

Bullies in the operating room have become so commonplace that nurses have even coined a term to deal with the dilemma.

“You call a code pink,” said June (not her real name), an RN from Ohio. “Everyone encircles the nurse who is being bullied and we tell the physician or whomever is doing the bullying that this is unacceptable behavior for a professional and it won’t be tolerated by the nursing staff.”

Yet sometimes, bullies aren’t deterred by a show of force.

June, an operating room nurse manager, experienced bullying for almost a year by a physician who screamed, physically threatened, and belittled her and the other OR nurses.

“He had all of the OR nurses in tears on a daily basis,” June recalled. “You never knew when you would be the target of one of his outbursts.”

June and the other nurses documented all of the incidents and attended seminars on how to deal with difficult people.

“The techniques they taught us worked on other people, but nothing worked on this particular physician,” June said.

She documented all the incidents, appealed to management and human resources, and followed hospital policy. She and her coworkers ultimately lost their jobs as part of a reduction in force while the physician was allowed to stay in his position. Nine months later, the physician threw a male nurse against a wall, and the hospital finally took action, transferring him to another position. A lawsuit is pending.

But the lawsuit came too late for June, who thinks the system failed her and the other nurses.

“It took an actual act of physical violence before the hospital administrators took the complaints of the OR nurses seriously,” June said. “By finally acting on the situation when a male nurse became involved illustrates that hospital administration condoned the behavior as long as it affected only female nurses.”

The scenario of bullying has become all too prevalent in hospitals and workplaces across the United States.According to Namie’s most recent studies for 2003, 70% of people targeted by a bully leave their workplace, 33% for their health, and 37% because they were victims of a performance appraisal system manipulated to show they were incompetent.

Data for Namie’s studies were gathered in 2003 from anonymous and confidential online surveys that were posted at the website bullyinginstitute.org, a “nonscientific” sample of 1,000 volunteer respondents who visited the website seeking solutions to their vexing problems at work attributed to a directly experienced cruelty from one or more persons. Human resources experts peg the cost of replacing an employee at two to three times that person’s salary.

Health care costs also may rise for a company, as a bully’s targets become affected by stress-related illnesses. According to Namie, 39% of bully targets become depressed, with 41% of targeted women and 37% of targeted men being diagnosed with post-traumatic stress disorder. “Bullying is a silent epidemic that affects one in six workers,” Namie said.

To successfully combat bullying in the workplace, Namie recommends using the following strategies:

> Stop listening to the bully’s lies and verbal assaults. Too many people internalize the bully’s actions, start questioning their own skills, and become steeped in self-blame just like a domestic violence victim, Namie said. Realize that bullying is a form of psychological violence. Begin by warning the bully that his or her behavior is unacceptable.

> Take a time-out. Namie says it’s crucial to have a bullyproofing period away from the workplace, where victims can talk to a counselor and get their health together. “Employees need to seek outside assistance,” Namie said. “Talking to your HR department won’t help because they support management.”

> Look for new opportunities. This is also a good time to begin a job search before your health deteriorates. “Once you’ve been targeted by a bully, you have a 70% chance of losing your job,” Namie said. “It’s better to leave on your own with your health still intact.’

> Begin bullybusting. The only successful option for fighting a workplace bully is documentation. “You need to present to the employer why it’s too costly to keep this bully employed,” Namie said. “Make a business case by showing the high turnover in your department, increase of sick time, the number of employees on antidepressants, etc.”

Bullybusting also can prove effective if workers band together to confront the bully.

“Coworkers need to support whomever is being targeted by the bully,” Namie said. “Approach the bully together and let them know this is unacceptable behavior and it will no longer be tolerated.”

Combat bullying

Donna McNeese-Smith, RN, EdD, has met many bullies in the 17 years she worked as a nurse administrator. An associate professor of nursing at UCLA, McNeese-Smith now teaches her nursing administration graduate students how to combat bullying and other nonprofessional behaviors within their own medical facilities.

“I truly believe it’s the job of the nursing administrator to protect their staff against this harmful practice,” she said.

“Nurse managers need to be adopt a zero tolerance policy against bullying. They wouldn’t allow inappropriate sexual harassment or domestic violence in the workplace, and bullying is just one more destructive behavior.”

Taking a stance against bullies is also imperative given the nursing shortage. Administrators need to stand up for their staff — or risk losing valuable nurses.

McNeese-Smith recommends nursing administrators make certain that staff have clear policies on dealing with verbal abuse and know they can rely on their managers to enforce respectful relationships and communication.

Confronting this kind of behavior is an important part of the nurse executive’s job, and nursing administrators must be prepared to firmly confront this behavior.

“If nurses don’t receive validation from administration, they need to find a job elsewhere,” McNeese-Smith said. “There’s no reason to continue working in an environment that is damaging your health.”