b'| AWARENESS GUIDEThe Link Between Bullying and Adverse OutcomesI t should come as no surprise that abusive behavior in the healthcare setting has a negative impact on patient care. Consider the 2018 Medscape report on the side effects of workplace bullying in healthcare that found the intimidating and disruptive behav-iors associated with workplace bullying fuel medical errors and lead to preventable adverse outcomes. For example, patients of disruptive physicians experience 14 percent more complications in the month post-surgery than those patients treated by surgeons with better bedside managers. In addition, more than 75 percent of disruptive behaviors led to medical errors, with 30 percent contributing to patient deaths. The same study examined the effect that workplace bullying has on each element of the Triple Aimimproving health, the patient experience and reducing cost. The report found that bullying behaviors negate quality performance at every turn, with the inci-dence of workforce trauma specific to bullying taking a hefty toll. For example:20 percent of targets meet the criteria for post-traumatic stress disorder. Suicidal ideation related to workplace bullying has been recorded at greater than 30 percent. Staff subjected to workplace bullying are twice as likely to commit suicide. Reference edLearnMediaInc.,2018.AccessedSeptember29,2020.[https://www.icd10monitor.com/Mthe-side-effects-of-workplace-bullying-in-healthcare]SOURCES AND SYMPTOMS OF BULLYING Another theory relates to nurses whoported, via employee assistance programs, Healthcare workers frequently find them- may have been bullies in childhood or ado- chaplains and, above all, their leaders. If the selves at increased risk for workplace vio- lescence, and never outgrow the mindsetsupport and efforts needed to help the tar-lence or bullying.and behaviors, she continues. Bullyinggeted nurse arent there, it might result in There are several theories as to why bul- behaviors are learned behaviors. Oncethe nurse leaving the unit, the hospital and, lying is prevalent in the healthcare setting,a bully learns how to get what he or shesometimes, the profession. says Terri Townsend, MA, RN, CCRN- wants through bullying, the behaviorsBullying victims tend to internalize and CMC, a unit-based educator, cardiovascu- continue and contribute to the toxic worksuppress the symptoms of bullying as long lar and outpatient services at Communityenvironment. as possible, says Townsend. But there are Hospital Anderson in Anderson, Ind.These behaviors can manifest themselvessymptoms that colleagues can identify. One is oppressed group behavior, saysin various ways, such as eyerolling, sarcasm,Outward signs can include avoiding the Townsend. Hospital hierarchies tend toyelling or excluding behaviors, says Kaybully by taking assignments as far away as be set up as line-authority structures, withClevenger, MSN, RN, a clinical educator inpossible, becoming anxious when the bully nursing staff on the lower end. the intensive care and acuity adaptable unitsenters a room or nurses station, refusing to This structure tends to contribute to theat Indiana University Health West Hospital.ask the bully for help, even if that is the only individuals lack of control over his or herIn some cases, the bully might be an expe- person available, and withdrawing socially own situation, says Townsend, and mem- rienced professional with strong clinicalfrom other staff members, says Townsend. bers of the group begin to act out againstskills who does not identify themselves asIncreased absences can also be a sign of each other as a way of feeling like they area bully, says Clevenger.being bullied, as are physical maladies such in control.They believe they are helping the neweras headaches or an upset stomach.Weaker members of the group tend tonurse develop high standards. Once or if the become victims. In addition, nurses havenewer nurse has the courage to stand up toENCOURAGING A CULTURE OF SAFETYtraditionally been in subordinate positions,the bully, the bullying may cease, she says,Ideally, bullying will never take place in your whether with physicians or hospital admin- noting that the employee or patient being bul- facility. Your healthcare system should take istration. Bully nurses learn early on whichlied must document specific occurrences ofpains to create a culture that actively dis-staff members will be victims and whichthis behavior, and talk to a manager about it.courages bullying, but also must be pre-ones should be left alone. The targeted person also needs to be sup- pared to react accordingly when abusive www.elitecme.com |2020| AWARENESS GUIDE 21'