Nurses call it "lateral violence" when bullying occurs within the group. Sadly, the axiom "nurses eat their young" is considered normal. That makes bullying an occupational hazard that goes unchallenged. It need not be this way.
Nurses tend to lead every anti-bullying initiative we are involved with in hospitals. They are the leaders.
For comprehensive institutional change in healthcare, physicians have to be involved. And some forward-thinking physicians have attended University. They go home to educate their colleagues.Rationale for Attending: The Joint Commission Compelled Recognition of Bullying
The Joint Commission wisely named its July 9, 2008 Issue 40 Sentinel Event Alert "Behaviors that undermine a culture of safety." It is abundantly clear that through the undermining of employee safety, disruptive individuals threaten patient safety, the core mission of every JCAHO-accredited hospital or organization.
In response to this safety threat, effective January 1, 2009, The Joint Commission promulgated a new Leadership Standard (LD.03.01.01) to address intimidating, disruptive and inappropriate behaviors. JCAHO cited research demonstrating that negative interpersonal conduct by physicians and others can lead to medical errors, preventable adverse patient outcomes, poor patient satisfaction, increased cost of care, increased malpractice risk, and turnover among professionals who have to deal with the abusive actors.
The phenomenon of Workplace Bullying most accurately describes the set of overt actions that JCAHO is proactively addressing in this leadership standard.
Healthcare is institutionally prone to bullying because of its unique mix of highly-skilled and educated individuals interacting in an environment charged by internal hierarchical and external challenges. The survey conducted by the Institute for Safe Medication Practices found that 61% of respondents said their organization dealt ineffectively with intimidators and 93% reported a medication error attributable to a professional's intimidating behavior. Research by the American College of Physician Executives reported that 38.9% of high revenue generating physicians seem to bully with impunity.
Existing Disruptive Physician policies are not effective. The problem is that fear of retaliation leads to serious under-reporting and accusations of employer negligence. Anti-harassment policies, compliant with state and federal laws, do little good unless the alleged offender is not a member of a protected status group. Sexual harassment and racial discrimination rarely apply in situations of status-blind cruelty. Organizational Value Statements declaring "Respect for all individuals" ring hollow without the power of enforcement.
If these policies and declarations had worked, there would be no broad-based evidence to compel JCAHO to take this extraordinary step to require attention to the work environment in healthcare organizations.
University graduates take home the materials and knowledge to launch an authentic anti-bullying initiative.