Introduction 

The American Nurses Association (ANA) advocates for the need of a healthy work environment for nursing staff that is devoid of any form of abusive behavior such as bullying, abuse of position and power, retaliation for being vocal against abuses, sexual harassment, bullying, and lateral violence and abuse among others. Lateral violence is characterized by acts of violence between nursing colleagues whereas bullying is often carried out by a person in a higher position of authority. Bullying and violence in the nursing practice may entail blatant or conceal acts of both nob-verbal and verbal hostility, which have been as causal factors for psychological distress among nurses and contributing to nurses to quit the profession. Bullying and violence in nursing workplace is extremely widespread, with the Institute for Safe Medication Practices reporting that 48 percent of pharmacists, nurses and other healthcare professional reporting strong verbal mistreatment. In addition, 43 percent of pharmacists and nurses amongst other healthcare personnel stated to have been subjected to a form of intimidating body language. Another research by Longo  indicated that 53% of student nurses had been insulted by practicing nurses. The aim of this research paper is to evaluate the impact of bullying and violence on nursing leadership practice and the healthcare system. This paper also explores the various ways through which nurses leaders can avoid bullying and violence between colleagues in the unit. This paper also makes commendations for the nursing profession’s future.

Impact of Bullying and Violence on Nursing Leadership Practice and Healthcare System

Bullying and violence is characterized by both psychological as well as physiological impacts on the victims including adverse effects on patient care and healthcare organizations. Nurses who are exposed to a work environment typified by bullying tend to have low levels of satisfaction, take more time on leave, and show lower levels of drive and efficiency. This poses a substantial threat on the wellbeing of nursing staff. Which in turn hinders their ability to deliver high quality healthcare. Lateral violence often entails aggression that targets nurses, perpetrated by colleagues in the unit. This lateral violence usually leads to a downward spiral that has been established to be costly to nurses, resulting in their dissatisfaction with work as well as psychological distress. Empirical evidence supports this view. For instance, Lowenstein  reported that bullying had a deleterious effect on the self-image and self-confidence of victims, which subsequently compelled victims to quit their job or unwillingly embrace they were victims of bullying. In this respect, the author reported that about 40 percent of practicing clinicians in the study reported keeping quiet or ignoring instances of improper medication because of an intimidating co-worker. Similar assertions have also been made by other authors such as Yildirim, who pointed out that workplace bullying and violence of nursing staff plays a significant role in eroding the professional capability of nurses and resulted in an increase in employee attrition and sickness leave. Empirical research has also reported significant relationships between workplace violence and bullying, and health risks and dissatisfaction among nurses. Workplace bullying has also been reported to significantly lessen self-confidence and productivity while at the same time increasing mental health outcomes. 

Workplace violence can also have detrimental impacts on the body. The resulting stress associated with workplace violence and bullying is capable of resulting in various psychological and physiological signs such as rumination, fatigue, insomniac tendencies, depression, embarrassment, anger, panic, feelings of anxiety, stress, heart disease, high blood pressure, changes in weight, disorders of the stomach and headache among others. In addition, post-traumatic stress disorder can be experienced not only because of being a victim of workplace violence, but also through the secondary observation of co-workers being exposed to aggression. Nursing personnel exposed to lateral workplace violence are more likely to have issues in their intimate relationships, develop drug abuse problems, develop phobias, and experience isolation. In extreme cases, workplace bullying and violence can damage careers, and result in suicidal behaviors and thoughts among nursing personnel. According to Yildirim, the worst impacts associated with workplace violence and bullying include being exposed to annoyance, being excluded, exposure to isolation and vilification, resources deprivation, and preventing nurses from making claim to their rights. These impacts degrade the nurse’s professional identity of a person.

 

Workplace bullying and violence can also take a toll on the nursing workplace. Research affirms that about 60 percent of new nurses tend to quit their first positions just after six months because of the workplace violence and intimidation directed towards them. Feelings associated with dissatisfaction as well as frustration are among the factors contributed to lower levels of organizational commitments, increase in nursing staff turnover, and heightening the already spiraling nursing shortages. This is often manifested through higher levels of absenteeism among nurses, illnesses associated with stress, and reduced levels of job satisfaction. Nurses’ decision to quit the nursing profession has been linked to cases of workplace bullying and violence. This can lead to loss of healthcare services to the public while at the same time increasing the costs associated with healthcare. The effect of the resulting turnover does not have a negative impact on the budget of the organization, but also affects the ability of the organization to recruit new staff after it has developed a repute for tolerating workplace violence.

Workplace violence and bullying is not only detrimental to nurses, but also patients. Unchecked workplace vehemence and mistreatment results in an unfriendly environment, whereby nursing staff are more likely to report medical errors. Nurses with higher levels of dissatisfaction are likely to manifest their emotional state onto patients, which is likely to contribute to higher levels of patient discontent as well as poor patient outcomes. In addition, new nurse practitioners exposed in a hostile working environment are likely to manifest these newly acquired behaviors when caring for patients. This is manifested through deliberate delaying when responding to the needs of patients. When patients witness negative and hostile interactions between nurses, the patient trust in the healthcare professionals is significantly reduced. Bullying has a negative effect on the safety of patients. In a study by Institute for Safe Medication Practices, it was reported that 49 percent of nursing staff who participated in the survey stated that their previous intimidation experiences had changed the manner in which they deal with the questions regarding medication orders (order clarifications). The findings of the study showed that, at least once on a yearly basis, 40 percent of those who raised concerned regarding medication orders presumed it was accurate, or requested another practitioner to dialogue with the prescribing personnel, rather than communicating with the prescriber. About 75 percent of those with medication order concerns requested the assistance of their co-workers in interpreting medication orders and preferred not to seek validation from the seemingly intimidating prescriber. In addition, the study found out that 34 percent of those with medication order concerns opted not to question the prescriber because of his/her intimidating demeanor. Other notable issues mentioned in the study included nurses dispensing a medication despite the fact that they had inherent concerns, nurses being pressured to consent to the medication order, and nurse’s involvement in medication errors due to intimidation. The underlying inference from this observation is that workplace bullying and violence hampers effective communication in healthcare settings, which in turn worsens patient safety. 

How the Nurses Leaders Should Avoid Bullying and Violence between the Co-Workers in the Unit

For nurse leaders to address the issue of workplace violence and bullying in nursing practice, it is imperative that they cease pretending that the problem is inexistent. Nurse leaders have the responsibility of developing and implementing measures aimed at tackling the issue. This requires the adoption of short-term measures that target resolving the immediate problem, and long-term measures targeted at altering the culture of the organization (Lowenstein, 2013). A zero tolerance policy on workplace bullying and violence that is implemented using a top-down approach has been identified as an effective means of dealing with the problem of workplace bullying and violence. In this respect, nurse leaders and nurse educators and health practitioners in higher positions ought to set the example by exhibiting respectful behavior. In addition, individual accountability for respectful behavior must be reinforced within the workplace as well as in the clinical and academic learning settings. Nurse leaders should embark on empowering nurses to be vocal and offer assistance to each other when experiences cases of workplace violence and bullying. In most instances, nurses tend to be bystanders, observe passively, or ignore the cases of workplace bullying and violence happening in their surroundings. Eliminating this culture of silence requires nurse leaders to empower nursing staff to speak up and support one another in such a hostile work environment. In addition, nurse executives should focus on working collaboratively with nursing staff in order to cub any form of workplace bullying and violence. Nurse leaders should offer nurses with an opportunity to express their disquiet without the fear of retaliation.

It is also imperative for nurse leaders to be apt in investigating allegations of potential bullying and violence in the workplace. This requires the development of policies that condone such behavior and encouraging whistleblowing among nurses. A simple approach to this could involve the use of complaint and suggestion boxes in the workplace. In addition, nursing staff at all organizational levels should utilize empathy when interacting with their co-workers. The work environment ought to be perceived as a place that is physically and emotionally safe. This requires team members to be treated with both courteousness and reverence. It is also imperative for nurse leaders to ensure that any nurse raising complains should be confident that their issues will receive the due attention from the organizations and solutions to the problem found. This requires the identification and confrontation of those perpetrating bullying and violence, according them a fair hearing, and taking appropriate disciplinary measure and dismissal if need be.

Recommendation for the Future of the Nursing Profession

The current nurses; generation has the responsibility of ending the cyclic nature of workplace bullying and violence from being spread to the subsequent nurses’ generation. In this regard, it is imperative for formal nursing education to focus on increasing the awareness of the existence of the problem. First, the problem of violence and bullying in nursing must be acknowledged including its existence. This should be followed by a change in the collective beliefs as well as customs. Nurses feeling that they are victims of workplace bullying and violence ought to have correct records in helping to document and monitor the issue. Nevertheless, maintaining records is not sufficient. Institutional policies regarding workplace bullying and violence should be developed and implemented accordingly. In this respect, it is imperative for healthcare organizations to create formal systems and mechanisms for reporting cases of workplace bullying and violence. Moreover, workplace violence teams can be created together with updated institutional policies. Moreover, the safety culture is the paramount goal. This should be typified by a healthcare setting that promoted and allows respectful as well as open, effective communication to help enhance safe and high quality patient care. 

Conclusion

From the discussion, it is evident that workplace bullying and violence is a significant issue of concern for nursing practice. Its impacts are detrimental for nurse leadership practice and healthcare in general such as reduced care quality, interfering with healthcare communication affecting patient safety, increasing nurses” attrition, psychological impacts on nurses such as lessened self-esteem and self-confidence levels, and physical effects on nurses among others. The apparent detrimental impacts that workplace bullying and violence has on nursing staff highlights the significance of early intervention and the need for nursing staff to acknowledge that workplace bullying is occurring in order to help in curbing further workplace violence and bullying. As a result, nurse leaders have an obligation of developing measures aimed at curbing the problem through developing zero-tolerance policies for such behaviors, developing an environment characterized by open communication, and increasing awareness of the problem.

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